SS Quality - Care ManagementShift
Part-time Thank you for considering a career at Mercy Health
Organizes the sequence of patient care to attain maximum levels of effectiveness and efficiency in conjunction with desired quality, clinical and cost outcomes. Coordinates multiple strategies to insure care of all patients managed with minimal duplication of roles and processes. Participates in the team approach for coordination of care, composed of the physician, nurse and other direct and indirect providers and payers. Performs a wide variety of high-level patient care activities in the role of practitioner, educator, leader, coordinator, and researcher. Initiates discharge planning on admission through patient/family interviews and assessments.
Coordinates the plan of care with the primary care nurses, physicians and other members of the healthcare team to move patients through the system by reducing fragmentation, promoting collaborative practice, monitoring quality of care and addressing issues related to appropriate use of resources.
Gathers information about patient's home environment, family, relationships and social-economic conditions to assist to improve or restore their capacity for social functions. Makes appropriate referrals for all abuse, neglect and homeless patients.
Serves as patient/family advocate by evaluating and arranging necessary funding, treatment alternatives, timeliness and coordination of health services. Contacts appropriate third party payers to obtain appropriatecertification/re-certificationof hospital services.
Collaborates with interdisciplinary team, community agencies, physicians, patients and families to develop appropriate discharge plan. Coordinate communication of plan and assists with monitoring interdisciplinary documentation in the medical record.
Concurrently and retrospectively collects data, using established criteria, through review of medical records for UR and QA to support the monitoring and evaluation functions.
Collaborates with existing programs and departments to ensure appropriate resource utilization, quality management, case management and resolution of system issues for assigned patient population. Assist with clinical pathway development and collection of outcome measures.
Supports case management development activities and participates in research related to healthcare issues, professional and clinical issues, medical costs and system problems/issues. Collaborates with other programs and community agencies and serves as a consultant.
Proactively manages actual and potential denials, including review of denial with the physician, forward to denial analyst, and documentation of all denial activities.
Mission/Core Values: It is expected that all of the duties and responsibilities of this position will be performed in a manner consistent with Community Mercy Health Partners' Standards of Behavior (CARE; Compassion: seeks to understand, listen and explain; Advocate: is the voice for the vulnerable; Respect: demonstrates the highest regard for and welcomes all people; Excellence: commits to the highest standard of quality care, joyful service, and teamwork) and in a manner that reflects the core values of Community Mercy Health Partners which are: Excellence, Human Dignity, Justice, Compassion, Sacredness of Life and Service. All supervisors and above are expected to model the organizational mission and values through their daily actions, decision making and priority setting. All supervisors and above are expected to develop, implement and monitor short and long range plans to meet or surpass standards consistent with the overall strategic plan.
MINIMUM EDUCATION: 4yr/Bacholers Degree
Preferred Education: Graduate Degree
LICENSURE/CERTIFICATIONS(must be non-expired/active unless otherwise stated):
Registration and Current LSW or LISW in the State of Ohio
1-2 years clinical social work experience required; prefer 3-5 years acute care social
work, discharge planning, case management, utilization review or quality assurance.
Part-Time, 24 hrs/wk
MercyHealth is an equal opportunity employer.
We'll also reward your hard work with:
Scheduled Weekly Hours:
- Comprehensive, affordable medical, dental and vision plans
- Prescription drug coverage
- Flexible spending accounts
- Life insurance w/AD&D
- An employer-matched 403(b) for those who qualify.
- Paid time off
- Educational Assistance
- And much more
SS Quality - Care Management All applicants will receive consideration for employment without regard to race, color, national origin, religion, sex, sexual orientation, gender identity, age, genetic information, or protected veteran status, and will not be discriminated against on the basis of disability. If you'd like to view a copy of the affirmative action plan or policy statement for Mercy Health - Youngstown, Ohio or Bon Secours - Ashland, Kentucky, which is an Affirmative Action and Equal Opportunity Employer, please email@example.com.If you are an individual with a disability and would like to request a reasonable accommodation as part of the employment selection process, please contact The Talent Acquisition Team firstname.lastname@example.org