Company: Tuality Healthcare
Posted on: May 3, 2021
Analyzes patient medical records concurrently and/or
retrospectively for quality assessment and discharge planning
criteria. Provides supportive documentation and clinical records to
insurance carriers for authorization of services. Coordinates
discharge plans and orders for patients leaving the hospital
including identifying needs for community services and making
appropriate transition plans. This position requires creativity and
problem solving, multi-tasking, and the ability to prioritize tasks
and work with minimal supervision.
Performed majority of the time -- please start with the
responsibilities that are the most time consuming:
- Applies and shares knowledge of community health and social
- Evaluates medical information and completes discharge needs
assessments within 1 day of admission as set by established
criteria, to identify patients that are at high risk of requiring
post-hospital services, and the need for case management and
discharge planning intervention.
- Initiate and complete safe discharge plans for inpatients by
arranging Home Health referrals, complex drug therapy
interventions, outpatient clinic visits, skilled nursing
placements, intermediate care placements, assisted living
- Documents initial assessment of the patient and continually
assesses discharge needs through the continuum of care.
- Works closely with external vendor partners to arrange
post-discharge needs, maintains amiable and professional
relationship with vendors at all times.
- Assesses variables that impact health and functioning,
interprets clinical information and assesses implications for
- Issues Important Messages from Medicare (IMM), Medicare
Outpatient Observation Notice (MOON), and denial of services letter
following appropriate health plan or Medicare guidelines.
- Collaborates with Hospitalists and Multi-Disciplinary team
daily to facilitate the timely discharge of patients from the
- Enters Avoidable Days and Code 44 Documentation when
- Provides information to patients and families on "Advanced
Directives" when requested.
- Responds to outpatient and community questions and
- Screens patient's medical records concurrently and/or
retrospectively using pre-established screening criteria for
quality assurance and discharge planning.
- Facilitates discharge planning for the continuum of care.
- Facilitates placements or referrals as appropriate to meet the
patient's clinical needs/rights and are specific for neonate,
infant, pediatric, adolescent, adult and geriatric
- Reports suspected abuse, neglect, or unsafe discharge
environment to the appropriate agency.
- Develops an individualized case management plan that addresses
physical, vocational, psychosocial, age, cultural, financial and
educational needs and documents case management activities.
- Coordinates the appropriate services and resources needed.
- Communicates with patient/family/significant others and all
multi-disciplinary team members for appropriate post-hospital
- Consults with the social worker to identify appropriate social
- Provides insurance carriers with necessary information to
authorize follow-up care when necessary and obtains
pre-authorization for post-discharge services including Skilled
Nursing, Durable Medical Equipment, Home Oxygen, or
- Relays pertinent information to the Case Management Manager to
represent Case Management with internal medical or quality
committees, inpatient nursing staff, ancillary provider staff as
Performed occasionally but critical to successful performance of
- Attends scheduled staff, care conferences, and other meetings
- Attends Utilization Review Committee meetings as schedule
- Shares information from seminars and other sources of education
with others as appropriate.
Decision making and budget responsibilities (e.g. impact limited
to the employee, entire unit or organization-wide):
- Impact limited to the employee.
- Bachelor or Master of Science in Nursing. Current RN employees
as of 1/27/2020 will be grandfathered back to the previous
education requirement at their time of original hire.
- 2 years' experience practicing as an RN
- Strong clinical nursing skills with five (5) years hospital
experience in varied clinical settings.
- Knowledge of insurance carriers and Medicare guidelines in the
- Knowledge of community health and social service
Licenses, Certifications and/or Registrations:
- Current license as a Registered Nurse by the Oregon State Board
- American Heart Association Healthcare Provider BLS.
- Certification in Case Management from ACMA Or CMSA.
- Certified Medical Translator
Job Related Skills, Abilities and Behaviors:
- Demonstrates ethical commitment to quality assurance and
confidentiality of all data and information.
- Emulates dress code and Code of Conduct that incorporates
presenting a good first and lasting impression by personal
appearance and interpersonal skills.
- Advanced communication and interpersonal skills that utilizes
consideration body language, filters, listening, paraphrasing, and
questions with customers of diverse ethnic and cultural
backgrounds. This also includes the skills to obtain and interpret
information appropriate to patients' needs and age as required for
assessment, range of treatment and patient care.
- Ability to write clear and legible clinical notes.
- Experience working in highly confidential settings.
- Possesses excellent telephone skills and interpersonal
communication abilities both verbal and written.
- Ability to develop case management care plans and solutions
utilizing critical thinking and problem-solving skills.
- Familiar with computerized word processing and electronic
- Ability to implement ideas and programs required.
- Self-directed and must be able to follow through on projects
with attention to detail and implement ideas and programs with
- Demands creativity, flexibility and the ability to work under
- Applies problem-solving techniques to the case management
- Maintains familiarity with disease processes, available
resources and treatment modalities, assessing their quality and
appropriateness for specific disabilities, illnesses and
- Provides care appropriate to the age of patients served
pediatric, adolescent, adult, and geriatric patients based on
principles of growth and development and life stages.
- Demonstrates confidentiality according to PHI regarding patient
and co-worker information.
- Demonstrates an understanding of insurance policy language and
various health care options.
- Responds to correspondence independently, as appropriate.
- Exhibits the ability to learn "just in time" and shares
findings with others.
- Demonstrates ability to work in a team situation.
- Ability to facilitate family care conferences, manage multiple
interruptions, communicate effectively with patients and act as
- Advocates and respects patients' rights and/or significant
- Utilizes problem-solving techniques consistently to resolve
complaints or concerns.
- Maintains a cooperative and harmonious relationship with staff
- Demonstrates respect of others, communicates clearly and
attempts to resolve interpersonal conflicts.
- Develops and maintain collegial relationships with other
professionals by attending continuing education and professional
OHSU Health Hillsboro Medical Center, formerly Tuality
Healthcare has always been committed to our community. It's a part
of how we care for each other, and part of what makes this place
We had a humble start in 1918 when an enterprising woman named
Minnie Jones Coy started a small six-bed hospital in her Hillsboro
home. She brought together independent physicians under one roof to
treat the sick and provide a safe place for mothers to give birth.
A century after Minnie made her commitment to the people of
Hillsboro, her vision continues as we provide world-class health
care to patients.
As part of our affiliation with OHSU Health, we've changed our
name to Hillsboro Medical Center. This new moniker reflects our
expanded services and clinic locations that provide patients living
in Hillsboro and western Washington County greater access to
primary and specialty care.
Additional Posting Information
Hillsboro Medical Center believes in providing equal employment
opportunities for all qualified individuals. Recruitment, hiring,
promotions, transfers, working conditions, training, and
compensation will be based on qualifications without regard to
race, color, sex, sexual orientation, gender identity, religion,
age, creed, national origin, marital status, family relationship,
veteran status, genetic information, physical or mental disability,
or any other status or characteristic protected by applicable law.
We further commit ourselves to continuing the practical application
of this policy in our daily business conduct.
Keywords: Tuality Healthcare, Hillsboro , Case Manager-82002, Other , Hillsboro, Oregon
Didn't find what you're looking for? Search again!