JOB SUMMARY Develops an integrated link between patients, families, local resources, insurance representatives and hospital, enhances communication among these parties to assure appropriate and timely utilization and access to services and exchange of information, therapeutic interventions and advocates for the rights and needs of patients. ESSENTIAL FUNCTIONS ASCERTAINS PATIENTS MEDICAL, PSYCHOLOGICAL, EMOTIONAL AND SOCIAL NEEDS By interviewing patient, completing initial care management assessment, screening for potential discharge planning needs, communicating with treatment team. DEVELOPS THERAPEUTIC INTERVENTION PLAN ACCORDING TO NEEDS By exploring options, setting goals, establishing rapport with patient and significant others. OBTAINS SERVICES AND RESOURCES FOR PATIENT By ascertaining appropriateness and referring to community resources Establishing rapport with agencies and support groups Arranging appointments REPRESENTS RIGHTS AND NEEDS OF PATIENTS By educating and informing patients about their rights Advocating on their behalf with community resources, insurers, treatment team COORDINATES TREATMENT AND DISCHARGE PLAN By leading interdisciplinary team meetings Bridging communication between team members, ancillary departments, insurers and significant others. MAINTAINS DOCUMENTATION By appropriate and timely notations in the medical record, departmental files, hand-off communication documents (i.e. POD report), electronic documentation systems and databases. ADDRESSES PATIENT SAFETY By identifying and communicating patient safety issues to the team, patient/family Relaying recommendations for a safe discharge plan to patient/family Assisting to resolve care issues by making referrals to address identified needs Reporting to regulatory agencies as required, facilitating appropriate utilization of services. Coordinates UTILIZATION MANAGEMENT ProcessES By reviewing clinical information based upon admission and continued stay criteria Performing concurrent medical reviews to communicate to payers Initiating physician advisor reviews for cases not meeting established criteria for admission and/or continued stay to facilitate appropriate utilization of services Communicating denials from third party payers to the physician and coordinating a timely appeals process Updating demographic information, Obtaining signatures on admission paperwork and/or advance directives forms (where applicable) DEMONSTRATES A PROFESSIONAL DEMEANOR AND MAINTAINS PROFESSIONAL KNOWLEDGE By being flexible, responding positively to unexpected changes in the work load and work hours Performing other duties as directed Keeping abreast of regulations and policies related to utilization management and discharge planning, departmental staff meeting information. QUALIFICATIONS To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Education Bachelors Degree required Masters Degree preferred Work Experience 1-2 years of related experience required Licenses / Certifications Clinical license in appropriate discipline preferred.