Job Summary The Case Management Specialist participates in a multidisciplinary team to coordinate high quality, cost efficient care for patients across the continuum. Case management is achieved through a collaborative process which assesses, plans, implements, coordinates, monitors, and evaluates options and services to meet patients' health care needs through communication and available resources to promote quality cost-effective outcomes.Minimum Qualifications BSN and current Maryland RN licenseThree years of clinical experience in a related area.Current BLS certificationPreferred Qualifications One year experience in case management or similar roleCurrent case management certificationKnowledge of Milliman and InterqualPrimary Duties and Responsibilities Contributes to the achievement of established department goals and objectives and adheres to department policies, procedures, quality standards and safety standards. Complies with governmental and accreditation regulations.Establish relationships with key personnel both within and outside St. Mary's Hospital to promote effective communication and fully support coordination of care linkages and resource management for the patient and familyCollaborate with the physician and health care team on level of care concerns and documentation of variances.Demonstrate the ability to develop a plan of care that addresses needs across the continuum; have an intervention for each problem identified; develop long- and short-term goals with specific time frames for resolution; identify specific services to be provided in the care plan; include the family/care-giver in the plan of care; and show life planning contingencies such as power of attorney and/or advance directives.Identify appropriate case management referral cases based on information collected from physicians, members of the health care team, families, review of the medical record and use of high risk screening criteria.Identify barriers to high quality health care, such as the need for interpreter services and follows through with resolutions.Perform detailed assessments of assigned cases that include: Current health status of the patient including benefit coverage for all areas; Assessment of physical, psychological, and social needs of the patient; Identification of cultural influences on illness or injury; Identification of risks and hazardous home environments; and assessment of ability to perform activities of daily living and need for functional support.Understand concepts of utilization management and able to determine level of care status and whether the documentation by physicians and health care team supports the level of care.Assists with the development of departmental policies and procedures in support of clinical resource management.Performs other duties as assigned.About MedStar Health MedStar Health is dedicated to providing the highest quality care for people in Maryland and the Washington, DC, region, while advancing the practice of medicine through education, innovation and research. Our 30,000 associates and 5,400 affiliated physicians work in a variety of settings across our health system, including 10 hospitals and more than 300 community-based locations, the largest visiting nurse association in the region, and highly respected institutes dedicated to research and innovation. As the medical education and clinical partner of Georgetown University for more than 20 years, MedStar is dedicated not only to teaching the next generation of doctors, but also to the continuing education and professional development of our whole team. MedStar Health offers diverse opportunities for career advancement and personal fulfillment.