Job Description
Job Summary: Responsible for working collaboratively with physician partners to optimize quality and efficiency of care for hospitalized members by carrying out daily utilization and quality review, monitoring for inefficiencies and opportunities to improve care, developing a safe discharge plan to include recommending alternative levels and sites of care when appropriate. The activities will include daily review of hospital care by chart review and discussion with attending physician, admission and concurrent review for inpatient admissions, meetings with patient and families to develop discharge planning, identification of patients for ambulatory case management, communication with case managers, home care reviewers, social workers, members and providers, quality improvement reviews, and education of the member/family, provider and hospital staff. Achieves desired utilization and quality outcomes and promotes high customer satisfaction to the population served. Essential Responsibilities: Plans, develops, assesses and evaluates care provided to members. Collaborates with physicians, other members of the multidisciplinary health care team and patient/family in the development, implementation and documentation of appropriate, individualized plans of care to ensure continuity, quality and appropriate resource use. Reviews, monitors, evaluates and coordinates the patients hospital stay to assure that all appropriate and essential services are delivered timely and efficiently. Communicates via huddles with hospitalist partner multiple times throughout the day . Reviews all new inpatient admissions within 24 hours and begins the discharge planning process immediately. Assesses high risk patients in need of post-hospital care planning. Develops and coordinates the implementation of a discharge plan to meet each patients identified needs; communicates the plan to physicians, patient, family/caregivers, staff and appropriate community agencies to enhance the effect of a