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Day - 08 Hour (United States of America) This is a Stanford Health Care job.A Brief Overview
Complex Care Managers are highly-skilled, licensed healthcare professionals responsible for maximizing the efficiency and effectiveness of health care interventions necessary for a patient to attain the optimal results from his or her plan of care. They are dedicated to patient and family centered care that values personal self-determination, enjoy managing multiple priorities at once, and engaging in creative, compassionate and ethical problem-solving. As a member of a multidisciplinary health care team, Care Managers perform comprehensive assessments and develop treatment plans that integrate the medical, social, and financial issues that impact individual patients, families, and populations. Care Managers are responsible for working collaboratively with all healthcare team members to develop and implement treatment plans that support the patient-centered plan of care for both individual patients and the service-line. Care Managers act as consultants to the clinical team, service lines, and other departments regarding patient assessment and patient care and participate in program development and quality improvement initiatives. In their role, Care Managers, by applying guidelines and collaborating with multidisciplinary teams, influence and direct the delivery and quality of patient care.
Care Managers are assigned to a group of patients by medical specialty, unit, or clinic, and some activities may differ depending on the needs of the population. Major responsibilities include coordinating all facets of a patient's admission/discharge or outpatient visit/follow-up; performing utilization review activities, including review of patient charts for timeliness of services as well as appropriate utilization of services; and ensuring optimum use of resources, service delivery, and compliance with external review agencies' requirements. A health-system case management program has as its primary goal to ensure the most appropriate use of services by patients and, toward that end, to avoid duplication and misuse of medical services, control costs by reducing inefficient services, and improve the effectiveness of care delivery.Locations
Stanford Health CareWhat you will do
- Advocacy & Education: Patient/Family Self Care Management, Patient/Family Health Management Education, Bioethics Referrals & Management, Physician, Staff & Community Education, Case Management Education & Training, Risk Management Identification & Referral
- Clinical Care Coordination/Facilitation: Plan of Care & Outcomes Management, Patient Care Integration, Resource Management, Patient/Family Care Conferences, Interdisciplinary Care Communication/Coordination, Continuity of Care Planning Management.
- Continuity/Transition Management: Capacity/Access Management & Throughput, Discharge Planning, SNF/Rehab/LTAC/Assisted Living Placement, Board and Care/Attendant Care Placement, Transportation & Travel Arrangements, DME, Home Health/Home Infusion, Mental Health Service Coordination, Hospice
- Dialysis Coordination & Arrangements, Pharmaceutical Authorization/Management, Community Resource Coordination, Advance Directives, Palliative/End-of-Life Care, Health Care Resource Management/ Clinical Cost Efficiency, Financial Assistance/Referrals, Appeals Management, Entitlement Program Coordination, Patient Benefits Coordination: CCS/GHPP/Medicare/Medi-Cal/SSI
- Performance & Outcomes Management: Federal/State/Local Regulatory Agency Compliance, Joint Commission Standards Compliance, Clinical, Documentation Education/Support, Clinical Guidelines/Pathways/Evidenced Based Practice, Organizational Financial Performance/Management, length of Stay, Cost per Case, Denial Management
- Psychosocial Management: Crisis Intervention, Psychosocial Assessment/Functioning, Counseling Support & Referral, Abuse/Neglect Identification & Referral (Partner, Child, Elder), Family Issues Affecting Care, Coping/Emotional Adjustment, Grief/Bereavement Support (Individual & Group), Adoption Resources, Health/Wellness Promotion, Substance Abuse Screening/Resources, Psychiatric Screening/Behavior, Management, Staff Support and Crisis Intervention (Critical Incident Stress Debriefing)
- Research & Practice Development: Clinical Practice Improvements, Evidenced Based Clinical Practice, Social Work Best Practice Standards Development, Social Work Competency Development, Case Management Best Practice Standards Development, Case Management Competency Development
- Utilization Management: Avoidable Delay Identification, Intervention & Tracking, Utilization Review, Medical Necessity Review, Care Plan Progression, Pre-Admission Planning, Third Party Payer Communication, Level of Care Appropriateness Coordination, Admission Status Determination, Clinical Denial Prevention
- Master's degree in work related discipline/field from an accredited college or university. PharmD, DPT, MSOT or other degree associated with clinical license may be considered.
Required Knowledge, Skills and Abilities
- Three (3) years of progressively responsible and directly related work experience
Licenses and Certifications
- Knowledge of contemporary case management principles and practice methods, including assessment, treatment planning, utilization management, and quality assurance
- Ability to use multiple electronic systems, software programs, and the internet to review and record information
- Knowledge of medical terminology and related levels of care and treatment
- Ability to collaborate across disciplines to provide comprehensive, integrated care.
- Ability to develop and implement educational materials and presentations for all levels of learners.
- Ability to develop appropriate treatment plans, communicates with interdisciplinary teams, and coordinates care.
- Ability to monitor and assure the patient's access to the appropriate level of care; the right health care providers; and the correct setting and services to meet the patient's needs; promote coordination and continuity in patient health care
- Ability to provide age-appropriate assessments, interpretation of data, and delivery of interventions
- Ability to provide appropriate patient care and clinical information when patients are admitted, referred, transferred, or discharged
- Ability to remain knowledgeable regarding available treatments and services
- Ability to resolve conflicts and/or negotiate with others to achieve positive results; establish and maintain effective interpersonal relationships
- Ability to understand, interpret and apply complex federal and state hospital compliance laws, rules, regulations and guidelines
- Knowledge of financial processes of various private and public funding sources for health care services/procedures
- Knowledge of hospital operations, organization, systems and procedures and laws and regulations pertaining to the operation of hospitals in California
- Knowledge of the full continuum of care available to patients, interrelationships of the care components, and their effective integration
These principles apply to ALL employees:SHC Commitment to Providing an Exceptional Patient & Family Experience
- RN - Registered Nurse - State Licensure And/Or Compact State Licensure
- LCSW - Licensed Medical Social Worker - State Licensure
Stanford Health Care sets a high standard for delivering value and an exceptional experience for our patients and families. Candidates for employment and existing employees must adopt and execute C-I-CARE standards for all of patients, families and towards each other. C-I-CARE is the foundation of Stanford's patient-experience and represents a framework for patient-centered interactions. Simply put, we do what it takes to enable and empower patients and families to focus on health, healing and recovery.
You will do this by executing against our three experience pillars, from the patient and family's perspective:
Equal Opportunity Employer Stanford Health Care (SHC) strongly values diversity and is committed to equal opportunity and non-discrimination in all of its policies and practices, including the area of employment. Accordingly, SHC does not discriminate against any person on the basis of race, color, sex, sexual orientation or gender identity and/or expression, religion, age, national or ethnic origin, political beliefs, marital status, medical condition, genetic information, veteran status, or disability, or the perception of any of the above. People of all genders, members of all racial and ethnic groups, people with disabilities, and veterans are encouraged to apply. Qualified applicants with criminal convictions will be considered after an individualized assessment of the conviction and the job requirements.
- Know Me: Anticipate my needs and status to deliver effective care
- Show Me the Way: Guide and prompt my actions to arrive at better outcomes and better health
- Coordinate for Me: Own the complexity of my care through coordination