Job Purpose & Position Overview: Responsible for planning, organizing, coordinating, evaluating and documenting clinical quality in the areas of the Outpatient, Inpatient and Emergency Departments and case management in the Emergency Department.
Specific Job Duties/Responsibilities:
- Demonstrates the WCHS core Mission, Vision and Values
- Enhances the current Quality Management process in the Inpatient, Out Patient, and Emergency Department.
- Works closely with the Quality Management Staff in planning, organizing and directing clinical quality operations and activities within the Inpatient, Out Patient, and Emergency Department.
- Helps maintain and establish policies to enhance the clinical quality program.
- Analyzes data related to quality indicators in these areas.
- Implements process changes based on the data.
- Performs concurrent and closed chart reviews as needed.
- Works with Quality Management, Director of Nursing, and Nurse Managers to find appropriate chart review indicators.
- Prepares quality reports as needed based on the current Quality Management schedule.
- Implements process improvements and follows up to ensure that the actions are sustained.
- Has knowledge of accreditation and regulatory standards.
- Submits reports to appropriate agencies needed for regulatory or financial reasons.
- Ability to show data in a way that is easy to interpret such as charts and graphs.
- Promotes cost effective outcomes.
- Participates in all Quality Meetings.
- Attends the morning safety huddle and the ED huddle on a daily basis.
- Attends all nursing staff and individual staff meetings.
- Attends Medical Staff when invited.
- Ensures there are appropriate quality measures in the Inpatient, Outpatient, and Emergency Department areas.
- Participates in the peer review process with direction of the Medical Director.
- Documents activities.
- Educates staff on quality issues and follows up to ensure appropriate changes have been made.
Case Manager
- Acts as a liaison to assure services are being provided to patients referred to private sector hospital for specialty referral care.
- Works closely with the Inpatient Case Manager, OP Case Manager, Hospital Social Worker and PRC Case Manager.
- Communicates frequently with the ED providers on patient issues.
- Works closely with Patient Referred Care (PRC) and attends the PRC meetings on a daily basis.
- Ensures those patients with high utilization of services are assessed and followed.
- Determines clients' requirements by completing intake interviews; determining need for therapeutic medical, psycho-social, and psychiatric evaluations; reviewing therapist evaluations, treatment objectives, and plans.
- Establishes treatment programs by setting schedules and routines; coordinating services being provided; arranging resources, including transportation and escort.
- Monitors cases by verifying clients' attendance; observing and evaluating treatments and responses; advocating for needed services and entitlements; obtaining additional resources; intervening in crises; providing personal support.
- Works with the ED staff to implement and maintain a call back program.
- Maintains clients' records by reviewing case notes; logging events and progress.
- Communicates clients' progress by conducting weekly interdisciplinary meetings and evaluations; disseminating results and obstacles to therapeutic team and family; identifying treatment influences.
Required Qualifications/Skills: Associate's Degree required; Bachelor's Degree preferred and one year proven experience as a Case Manager or Utilization Review or combination of education and applicable experience. Must possess a valid full and unrestricted Professional license as a Registered Nurse in any state of the United States of America, the Commonwealth of Puerto Rico, or a territory of the United States. Must have excellent communication skills and can relate easily to both patient and providers.
Training Requirements: As needed
Physical Requirements: Normal to light office work which includes the ability to lift up to 10 lbs. Regularly required to walk, stand, and sit for extended periods of time and use hands to operate computer keyboard, phone, and various office equipment.
Cognitive Requirements: Reading, writing, calculating. Above average social interaction skills. Reasoning/Analysis. Works with minimal to no supervision.
Language Requirements: Must possess the ability to read, write, and speak the English language fluently. Must be able to continually and effectively employ professional verbal and written communications skills.
Certificates, Licenses & Registrations: All applicants will comply with 45 CFR 1301, Subpart D, Section 1301.31, C and D, which require all prospective employees to sign a declaration prior to employment regarding all arrests and convictions of child abuse or violent felonies and to comply with PL 101-630 and PL 101-637 regarding criminal records check.
WCHS is an equal opportunity employer. Employment practices are free of discrimination. As provided by Federal Law, all qualified Native American applicants shall receive preference over Non-Native American applicants. In the absence of qualified Native American applicants, consideration will be given to all other applicants without regard to race, color, religion, sex, sexual orientation, national origin, age, marital status, veteran status, genetic information, disability or any other reason prohibited by law in provision of employment opportunities and benefits.
Please note the position description duties, responsibilities, and activities may change at any time with or without notice.
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