An autonomous role that coordinates, negotiates, procures services and resources for, and manages the care of complex patients to facilitate achievement of quality and cost efficient patient outcomes. Seeks out and resolves discrepancies and delays in the care delivery process, identifies positive and negative care trends and process obstacles Performs the primary role functions of assessment, planning, facilitation and advocacy, which are achieved through collaboration with the patient and those involved in the patient s care. Assures that appropriate services are generated in a timely and cost-effective manner by assisting the patient to propriately self-direct care, self-advocate, and make informed healthcare decisions to the highest degree possible. Responsibilities include, but are not limited to: positive relationship building, effective written/verbal communications; negotiation; knowledge of contractual or risk arrangements; and ability to effect change, perform ongoing evaluation and critical analysis, plan and organize effectively and promote client/family autonomy. Conducts admission and continued stay review on patients, in accordance with the PPO and/or HMO contracts, InterQual and other classifications as designated by the Utilization/Case Management Review Plan. Identifies trends and patterns of resource use and patient care, and makes recommendations in compliance with established policy and procedure. Ensures continuity of care for patients with post-hospital health care needs and maximizes the patient s and family s abilities to meet the continuing care needs within their social and financial framework. Understands and applies the principles of growth and development to assess a patient s age specific needs to ensure appropriate treatment and care. Minimum of one year experience in Case Management/Utilization Management or Home Care.Minimum of 1 year hospital experience.Successful completion of all Orientation Programs Newark Beth Israel Medical Center is an Equal Opportunity Employer.
RWJBarnabas Health is an Equal Opportunity Employer