Integrated Care Case Manager - Patient-Centered Outcomes

Description General Summary : The Case Manager coordinates and manages services provided to each patient to establish a focused, individualized program geared towards specific goals unique to that patient. Acts as a liaison for patients, families, and staff, overseeing day-to-day operations of all care provided to ensure successful patient outcomes. The Case Manager is actively involved in department activities, transdisciplinary team activities, and LifeCare activities to ensure individualized, patient-centered health care for all patient populations admitted to LifeCare Hospital. Patient Population : Has contact with patients in a clinical setting; understands and demonstrates appropriate behavior when interacting with patients in the adult (18-65 years of age) and geriatric (65 and older) populations. Supervision : Does not direct or supervise the functions of the department. Standard Essential Functions 1. The knowledge and skills necessary to perform the position requirements are demonstrated through the successful completion of competencies established for the position, to include population served and other special needs of patients or customers, served by the department. 2. Adheres to LifeCare policies, procedures, all safety plans, and all standards imposed by regulatory organizations. 3. Regular attendance and timeliness is required. Job-Specific Essential Functions 1. Enables the patient’s program to proceed in an orderly, purposeful, and goal-directed manner through daily contact with the patient and family, attending patient staffings and weekly team meetings, monitoring patient progress, and re-evaluating goals. 2. Documents in patient chart and completes patient progress reports indicating problems, progress, treatment, and goals in a clear, concise manner. 3. Strives to direct all patient care and transdisciplinary efforts towards a maximum level of self-care for each patient. 4. Encourages the participation of the family and patient on an ongoing basis in discussion of plans, goals, status, etc. by directing patient and family at family/team conferences and through daily communication. 5. Facilitates the exit/discharge process and arrangements for follow-up and appropriate supportive services. 6. Performs psychosocial evaluations, counseling, and gathers information related to the patients’ current and ongoing overall status from patient, family, and medical documentation. Values • We COLLABORATE : We develop our treatment plans in collaboration with physicians, clinicians, and patient's families. • We ADVOCATE : We advocate on behalf of every patient and family. • We RESPECT : We recognize and value the dignity, rights, and resources of each patient. • We PROVIDE : We provide complex medical care with purpose and compassion. • We SERVE : We serve as a TEAM with integrity at all levels focused on achieving the best possible outcomes for our patients. Qualifications Experience : Minimum of four years experience in social services, counseling, case management, vocational rehabilitation services, or nursing preferred. Education : Bachelor’s degree in nursing or social work or combination of an associate’s or other two-year degree and meaningful and appropriate experience. Licensure/Certification : Currently licensed as a Social Worker or Registered Nurse in state where currently practicing. Certification in Case Management preferred. All Case Managers must maintain current licensure while employed with LifeCare Hospitals. Physical Requirements : 1. Ability to lift, move, transport and position equipment or supplies/materials up to ten (10) pounds without assistance; or over ten (10) pounds with the aid of mechanical assistance or assistance of personnel. 2. Range of motion and mobility of self by positioning or moving around hospital to include sitting, standing, walking, bending, squatting, stooping, kneeling, crawling, climbing, and reaching. 3. Ability to communicate with patients, families, physicians, co-workers, and visitors to be able to exchange accurate information regarding patient condition and health status. Ability to exchange and express information by means of language and communicate information effectively. 4. Ability to hear the nature of sounds. Ability to detect clinical alarms and conversation. Ability to give full attention to what other people are saying, taking time to understand the points being made, asking questions as appropriate, and not interrupting at inappropriate times. 5. Ability to use logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions or approaches to problems. 6. Ability to monitor/assess performance of yourself to make improvements or take corrective action. 7. Ability to see things at close range and match and/or detect differences between colors, including color and brightness. 8. Ability to make precisely coordinated movements of the fingers of one or both hands to grasp, manipulate, or assemble small objects. 9. Ability to keep your hand steady while moving your arm or while holding your arm and hand in one position. 10. Ability to understand the implications of new information for both current and future problem-solving and decision making. Ability to use scientific rules and methods to solve problems. 11. Ability to identify problems and review related information to develop and evaluate options and implement solutions. 12. Ability to respond to emergency or crisis in a calm and professional manner and to act as a team member or team leader to resolve the crisis or emergency. 13. Ability to work independently and perform routine and detail-oriented tasks. Ability to manage one’s own time. 14. Ability to consider the relative costs and benefits of potential actions to choose the most appropriate one. 15. Ability to collect and analyze numerical, written data and verbal communication to reach logical conclusions and ability to determine the time, place and sequence of operations or action. 16. Ability to review, assess, record or type data quickly and accurately. 17. Ability to observe and recognize or identify changes in patient’s health status or condition. 18. Ability to perform mathematical equations. 19. Ability to view and operate required equipment. 20. Ability to determine resources needed in order to provide quality patient care. 21. Ability to make independent judgments and decisions. Environmental/Working Conditions : 1. Category 2 - Infection exposure due to jobs in which required tasks do not normally involve exposure to blood, body fluids or tissues, but may require performing unplanned Category 1 tasks. In these jobs the normal work routine involves no exposure to blood, body fluids or tissues. However, potential exposure may be required as a condition of employment. 2. Ability to work alone or with minimal supervision. 3. Contact with patients, families, co-workers, physicians, and visitors. 4. Ability to work under and handle stress in an appropriate manner. 5. Ability to handle multiple tasks. 6. Ability to work long hours between breaks and meals may be required. 7. Exposure to high, medium, or low noise intensity. 8. Ability to take call as assigned may be required. Machinery/Tools/Equipment Requirements : Ability to operate telephone, fax machine, copy machine, computer, printer, and calculator. #J-18808-Ljbffr