Project Manager Inpatient Case Management

Reporting to the Director of Campus Administration/Campus Administrator, the responsibilities of the Project Manager include, but are not limited to, assisting with monitoring and (strictly) the non-clinical decision making aspects of care coordination, discharge, and post-discharge planning for inpatient members, including those inpatient members assigned to be case managed by the inpatient team as well as outpatient members when appropriate. In this role, the Inpatient Project Manager is responsible for monitoring the care efficiency of the inpatient members throughout the patient's entire care experience, both in the inpatient setting and outpatient. They are also responsible for knowing the inpatient facilities' contractual relationships and clinical capabilities.

Another responsibility is to monitor the transition process from the community (e.g., home) and/or institutional care setting (e.g., skilled nursing, assisted living, congregate, etc.) to and from an acute care setting (inpatient/long term care), as well as care under a hospice or palliative care setting.

This position acts as a liaison between medical management and the inpatient and outpatient case managers, coordinators, behavior health team, inpatient tertiary care teams, patient advocacy, member services, finance/claims, and other stakeholders involved in the care of our members.

In collaboration with other members of the Medical Management Team, the Project Manager is responsible for contributing to the team's efforts in increasing the overall value of the quality of care for Regal Medical Group's members, in line with Medicare's Value-Based Care Model. Ultimately, in carrying out their responsibilities, the Project Manager is consequentially responsible for contributing to the clinical, quality, financial, and patient satisfaction outcomes of Regal Medical Group.

• Essential Duties and Responsibilities include the following:

1. Coordinates a team of employed and contracted health care professionals (physicians, nurses, social workers, pharmacists, and other allied health professionals to optimize the patient transition experience form inpatient to community setting by managing home health visits as an instrument to improve patient safety and quality outcomes.

2. Coordinates activities from the various stakeholders (the patient, family members and friends, hospitalists, inpatient case management, PCP, visiting physicians and nurses and others) to create a seamless patient experience of transition of care.

3. Develops, monitors, and analyzes reports and identifies trends to develop programs and processes that improve program outcomes.

4. Thoroughly, accurately and timely track hospital discharges to determine which patients are required to have appointments at the Post Hospital Discharge Clinics.

5. Assists with the development and implement of training plans for new and existing staff.

6. Acts as a resource for clinical staff for case review and discharge planning.

7. Develops and coordinates strategies across the continuum of care for ensuring the delivery of care in the most cost effective setting.

8. Collaborates with the Regional Medical Director to analyze data and implement programs that will improve patient outcomes.

9. Develops annual department goals and objectives focused on improving patient outcomes and department efficiency.

10. Works collaboratively with the entire Medical Management team to ensure compliance with regulatory and health plan requirements.

11. Participates in “on call” process as needed for training and monitoring of home review staff.

12. Develop working relationships with hospital case management departments to facilitate timely reviews.

13. Oversees “triage” of patients to the appropriate level of care for the members of the home health team, and acts as a resource to other concurrent review nurses in the transfer process.

14. Works closely with other departments (claims, finance, high risk, CM, TOC) as needed.

15. Assumes other responsibilities as assigned.

16. Anticipate our customer needs: Understand the wants and needs of customers, listen for cues and identify how to respond and what level of intervention they need.

17. Survey the customer’s environment and take appropriate action.

18. Refrains from discussing personal business in front of the customer or speak a foreign language different from the customer’s language.

19. Greets patients, family members, and visitors, physicians in a positive manner by introducing self, speaking clearly and with confidence.

20. Returns phone calls to customers and follows up with requests.

21. Keeps patient/family member or other customer informed and requests if further assistance is needed.

22. Assists others and supports the team.

23. Demonstrates the ability to follow through with requests, sharing of critical information, and getting back to individuals in a timely manner.

24. Demonstrates honesty and integrity in every day activities.

25. Protects privacy for both patients and employees; ensures information sensitive papers, charts, and reports are not in view of the public.

26. Recognizes when an error has been made and immediately reports to appropriate manager.

27. Participates in “service recovery” through follow-up with an upset customer, gathering information, and demonstrates empathy.

28. Treats patients and their families with respect and dignity. Identifies and addresses psychosocial, cultural, ethnic, and religious/spiritual needs of patients and their families. Functions as liaison between administration, patients, physicians, and other healthcare providers.

29. Interacts professionally with patient/family/providers and involve patient/family/providers as appropriate.

30. Communicates appropriately and clearly to management, co-workers, and physicians.

31. Communicates using age appropriate language.

32. Understands and applies principles of adult learning methods as they relate to health care educational needs.

33. Consults other departments as appropriate to provide for an interdisciplinary approach to the patient’s needs.

34. Maintains quality monitors as determined by the Utilization Management and Quality Management Committees and RMG Management.

35. Performs other duties as assigned

36. Responsible for orientation, instruction/training of new personnel.

37. Pursues additional education (in-services, seminars, self study, and formal education programs) to advance nursing skills and knowledge.

38. Documents appropriately pertinent information completely, in the in the auth system according to nursing standards and policies.

41.Participates in the efficient, effective, and responsible use of resources such as supplies and equipment

42. All other duties as directed by management.

• Education and/or Experience:

1. High level knowledge of Concurrent Review/Case Management processes and principles

2. Prior experience in MSO environment preferred.

3. Ability to work with all levels of management.

4. Must have excellent communications skills both verbally and written.

5. Must have excellent organizational skills.

6. Prior experience with project development and implementation preferred.

7. Required to travel for new client implementation.

8. Requires current CA driver’s license and car insurance.

• Education and/or Experience:

1. High level knowledge of Concurrent Review/Case Management processes and principles

2. Prior experience in MSO environment preferred.

3. Ability to work with all levels of management.

4. Must have excellent communications skills both verbally and written.

5. Must have excellent organizational skills.

6. Prior experience with project development and implementation preferred.

7. Required to travel for new client implementation.

8. Requires current CA driver’s license and car insurance.