Description
:
DMC Rehabilitation Institute of Michigan is one of the nation’s largest hospitals specializing in rehabilitation medicine and research. RIM is known for its clinical expertise in spinal cord injury, brain injury, stroke, amputee, orthopedics and catastrophic injury care. The Institute houses the Center for Spinal Cord Injury Recovery and the Southeastern Michigan Traumatic Brain Injury System (SEMTBIS), one of only 16 federally designated model systems of care for brain injury care and research. RIM also operates 31 outpatient sites throughout southeast Michigan specializing in sports medicine and orthopedics.
Summary Description: Under general direction and according to established policies and procedures, develops and supervises the implementation of interdisciplinary treatment plans for patients in the inpatient setting at Rehabilitation Institute of Michigan. Collaborates with all members of the care team to help facilitate quality care in an effective and timely manner, at the most appropriate level of care.
- Performs continuous review of services to assure patient progress and maintains communication with families and professionals.
- Coordinates interdisciplinary team meetings to discuss each patients rehabilitation program with team, patient/family, insurance case managers / representative and other appropriate individuals involved in patient treatment.
- Recommends services for patients based on individual patient assessments, case documents and patient/family or insurance carrier preferences.
- On an ongoing basis, assesses level of care, diagnostic testing and procedures performed, quality and clinical risk issues, and participates in continuous performance improvement activities.
- Directs discharge planning through collaboration with treatment team and patient / family. Evaluates effectiveness of the discharge plan and continues to troubleshoot for patients / families post discharge.
- Serves as a patient advocate and provides therapeutic intervention and/or support as needed. Provides routine verbal and written documentation regarding assessment and client progress to appropriate parties. Refers all concerns regarding medical necessity, inappropriate utilization of resources or quality issues to management and to a physician advisor.
- Identifies non-acute days or delays in discharge and assesses causative factors.
- Establishes and maintains effective relationships with physicians and all other staff members, internally and externally. Identifies problems or any dissatisfaction experienced by any customer or referring source and works to resolve them to a high degree of service excellence.
- Uses positive interpersonal skills to effectively resolve conflict. Promotes a positive customer relations environment. Coordinates the utilization review function for assigned patients.
- Performs periodic concurrent review to assess need for continued stay. Contacts third party payers on cases requiring re-certification. Conducts reviews as needed to assist with reimbursement determinations or to assess quality of care issues.
- Participates in concurrent quality screening and collects data according to established guidelines. Makes referrals to Quality Management or Risk Management as necessary. Remains current on external agency regulations and assists with third party payer appeals as needed.
- Acts as a resource person and educator to other members of the multidisciplinary team, specifically in relationship to admission criteria, continued stay criteria, medical necessity criteria, payer regulations and discharge planning.
- Functions as a resource regarding insurance-related issues. Assists in monitoring performance consistent with TJC and CARF standards, and provides assistance in the creation/implementation of rehabilitation policies and procedures, goals and objectives.
- Maintains current knowledge of health care techniques/practices, and care management strategies through educational programs/resources. Maintains a working knowledge of the requirements of the payers most frequently seen with the patient population.
- Troubleshoots patient issues with patient accounting, as needed. Performs other duties and functions as assigned.
Qualifications
:
1. Masters degree in Social Work, Speech Language Pathology or related clinical field, or Bachelors degree in Physical Therapy, Occupational Therapy, Nursing or related clinical field, or the equivalent combination of education and/or related experience.
2. Current license, registration, and / or certification as applicable.
3. Three years of clinical experience.
4. Case management certification preferred.
