Monitors patient and family satisfaction. Responds to questions and complaints from patients, family members, and payers regarding care.Performs duties in a manner that promotes quality patient care/satisfaction, while promoting safety, cost efficiency, and a commitment to the continuous quality improvement process.Addresses system-level issues impeding diagnostic or treatment progress with the healthcare team and reports unresolved opportunities for improvement through the organizational defined escalation process (chain-of-command structure). Proactively identifies and resolves barriers to timely discharge/transition and documents avoidable delays information in accordance with health system protocols.Conducts an in-depth case management assessment of a patient’s needs at the time of admission and throughout the patient’s stay. Obtains and confirms information necessary for the development of a comprehensive discharge/transition plan of care.Clinically assesses, plans, implements, coordinates, monitors, and evaluates options and services to meet an individual’s health needs to facilitate a safe and timely discharge to the next appropriate post acute level of care.Collaborates with the Social Worker to proactively identify the need for team and/or patient and family conferences to facilitate discussion of the patient’s condition, discuss prognosis and determine an agreed upon transition of care plan.Consults with Physicians and multidisciplinary teams regularly to evaluate the patient’s status and appropriateness of medical care, including admission, length of stay (LOS), transfer, and discharge.Performs ongoing chart review to identify actual or potential issues, which may include service delivery, patient outcomes, satisfaction, compliance, cost, and reimbursement.Actively coordinates progress and the patient’s care by monitoring the length of stay (LOS) of the patient’s hospitalization, leads and facilitates rounds, and proactively works to meet expected length of stay and clinical targets/indicators.