Manager

• Communicates in an active, positive and effective manner to all health care team members
• Collaborates with staff from the interprofessional health care team to improve outcomes
• Uses a structured format for regular communication with patients and families
• Assesses all patients timely and thoroughly
• Participates in daily Care Coordination Rounds (CCR)
• Supports patients and families in preventing/resolving clinical or ethical issues
• Facilitates discharge planning activities for assigned patients
• Maintains ownership of the discharge planning process on assigned units
• Initiates and facilitates referrals for home health care, hospice, and durable medical equipment
• Consults with Social Worker Case Manager to assess psychosocial needs associated with transition to alternative levels of care
• Modifies care based on continuous evaluation of the patient's condition
• Documents accurate assessment and interventions efficiently and effectively
• Plans for routine discharge and elevates emergent situations
• Performs review for medical necessity of admission, continued stay and resource use
• Participates in denial mitigation activities to ensure appropriate reimbursement for services rendered
• Contributes to meeting department and hospital financial target
• Initiates evidence-based practice/performance improvement projects
• Seeks opportunities to identify self-development needs and takes appropriate action

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