General Summary of Position
The Case Management Specialist participates in a multidisciplinary team to coordinate high quality, cost efficient care for patients across the continuum.
Case management is achieved through a collaborative process which assesses, plans, implements, coordinates,monitors, and evaluates options and services to meet patients' health care needs through communication and available resources to promote quality cost-effective outcomes.
This position has a hiring range of $31.330000 - $51.267000
Primary Duties and Responsibilities
Contributes to the achievement of established department goals and objectives and adheres to department policies, procedures, quality standards and safety standards.
Complies with governmental and accreditation regulations.Establish relationships with key personnel both within and outside St.
Mary's Hospital to promote effective communication and fully support coordination of care linkages and resource management for the patient and familyCollaborate with the physician and health care team on level of care concerns and documentation of variances.Demonstrate the ability to develop a plan of care that addresses needs across the continuum; have an intervention for each problem identified; develop long- and short-term goals with specific time frames for resolution; identify specific services to be provided in the care plan; include the family/care-giver in the plan of care; and show life planning contingencies such as power of attorney and/or advance directives.Identify appropriate case management referral cases based on information collected from physicians, members of the health care team, families, review of the medical record and use of high risk screening criteria.Identify barriers to high quality health care, such as the need for interpreter services and follows through with resolutions.Perform detailed assessments of assigned cases that include:
Current health status of the patient including benefit coverage for all areas; Assessment of physical, psychological, and social needs of the patient; Identification of cultural influences on illness or injury; Identification of risks and hazardous home environments; and assessment of ability to perform activities of daily living and need for functional support.Understand concepts of utilization management and able to determine level of care status and whether the documentation by physicians and health care team supports the level of care.Assists with the development of departmental policies and procedures in support of clinical resource management.
Minimum Qualifications
Education
• Associate's degree in Nursing required and
• current Maryland RN license required or
• Master's degree in Social Work required and
• current Maryland Social Work license required and
• BSN preferred for RN preferred and
• Knowledge of Milliman and Interqual preferred
Experience
• 3-4 years Clinical experience in a related area.
required and
• 1-2 years Experience in case management or similar role preferred or
Licenses and Certifications
• BLS - Basic Life Support Current BLS certification required and
• CM - Case Management Current case management certification preferred
Why MedStar Health?
At MedStar Health, we understand that our ability to treat others well begins with how we treat each other.
We work hard to foster an inclusive and positive environment where our associates feel valued, connected, and empowered.
We live up to this promise through:
• Strong emphasis on teamwork-our associates feel connected to each other and our mission as an organization.
In return, our effective team environment generates positive patient outcomes and high associate satisfaction ratings that exceed the national benchmark.
• Strategic focus on equity, inclusion, & diversity-we are committed to equity for all people and communities.
We continue to build a diverse and inclusive workplace where people feel a sense of belonging and the ability to contribute to equitable care delivery and improved community health outcomes at all levels of the organization.
• Comprehensive total rewards package-including competitive pay, generous paid time off, great health and wellness benefits, retirement savings, education assistance, and so much more.
• More career opportunities closer to home-as the largest healthcare provider in the Baltimore-Washington, D.C.
region, there are countless opportunities to grow your career and fulfill your aspirations.
About MedStar Health
MedStar Health is dedicated to providing the highest quality care for people in Maryland and the Washington, D.C., region, while advancing the practice of medicine through education, innovation, and research.
Our team of 32,000 includes physicians, nurses, residents, fellows, and many other clinical and non-clinical associates working in a variety of settings across our health system, including 10 hospitals and more than 300 community-based locations, the largest home health provider in the region, and highly respected institutes dedicated to research and innovation.
As the medical education and clinical partner of Georgetown University for more than 20 years, MedStar Health is dedicated not only to teaching the next generation of doctors, but also to the continuing education, professional development, and personal fulfillment of our whole team.
Together, we use the best of our minds and the best of our hearts to serve our patients, those who care for them, and our communities.
It's how we treat people.
MedStar Health is an Equal Opportunity (EO) Employer and assures equal opportunity for all applicants and employees.
We hire people to work in different locations, and we comply with the federal, state and local laws governing each of those locations.
MedStar Health makes all decisions regarding employment, including for example, hiring, transfer, promotion, compensation, benefit eligibility, discipline, and discharge without regard to any protected status, including race, color, creed, religion, national origin, citizenship status, sex, age, disability, veteran status, marital status, sexual orientation, gender identity or expression, political affiliations, or any other characteristic protected by federal, state or local EO laws.
If you receive an offer of employment, it is MedStar Health's policy to hire its employees on an at-will basis, which means you or MedStar Health may terminate this relationship at any time, for any reason.
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