Case Manager_ GHC

Home Care Case Manager

Responsible for the case management of quality home care services rendered to patients.

Responsibilities:

1. Competent to apply age specific criteria as appropriate. Responsible for the assessment and treatment for patients of all ages, including neonates, child, adolescents, adults and geriatric.
2. Understands the cognitive, physical, emotional and chronological processes for all ages. Treatment reflects an understanding of the developmental needs for each patient.
3. Plans, implements, manages and evaluates the provision of both professional and ancillary home health services to ensure that all patient's needs are met and quality care is provided in accordance with Federal, State and agency guidelines.
4. Establishes and updates the care plan with written input from the patient/caregiver, physician and other multidisciplinary health team members.
5. Completes all required documentation according to agency policy and in a timely manner which include; interdisciplinary referral form, 485, OASIS, interim physician orders and coordination notes.
6. Familiarity with MLTCP and commercial payer requirements for care
7. Manages the activity of the multidisciplinary team providing care to patients as well as ensure that all visits scheduled and provided are authorized and covered by a physician order.
8. Reviews reports, evaluates ongoing patient care needs and communicates those needs to the physician.
9. Contact/follow up with physicians and other patient care providers when necessary to assist with care coordination.
10. Participate in staff/team meetings as required.
11. Maintains an ongoing responsibility for assigned caseload
12. Maintains proficiency in clinical and administrative skills.
13. Demonstrates sound judgment and independent problem solving skills in order to initiate appropriate intervention with regard to patient's psychosocial and/or physical impairment.
14. Facilitates the care of the patient in the home setting by utilizing appropriate community resources, counseling and teaching patient and patient's family and advocating on behalf of the patient.
15. Communicates case load and patient care issues to the Clinical Manager.
16. Updates the Home Health Aide plan of care, communicates with Home Health Aide Coordinator.
17. Develops, implements, and carries out a discharge plan in conjunction with the Primary field, patient/caregiver and members of the health care team. Interprets agency policy to patient and patient's families.
18. Ensures that all visits made have prior authorization if required by the patient's managed care insurance company. Works collaboratively with managed care insurance company.
19. Monitors the quality of therapeutic service through written and verbal communications with all disciplines. Participates in performance improvement activities, team meetings and orientation as requested.
20. Participates in case conferences and/or clinical rounds to provide guidance to care, while reinforcing best practices.
21. Participates in the agency's Quality Assurance Performance Improvement Program/PIP as designated or assigned.
22. Works with other members of the Interdisciplinary Team to develop appropriate interventions in order to achieve the clinical and functional goals of assigned patients.
23. Documents accurately, timely and completely in patient's clinical record in accordance with CMS/DOH regulations.
24. Write an accurate and concise clinical/progress note that reflects implementation of the plan of care and the patient's response to that plan of care.
25. Demonstrates sound judgment by taking appropriate actions regarding suspected violation of corporate compliance regulations.
26. Reports all suspected violations to supervisor, Compliance Officer or Compliance Hotline.
27. Performs other nursing activities as directed.

Qualifications and Experience:

• Graduate of an accredited School of Nursing required. BSN preferred.
• Current Registered Nurse license with NYS Department of Education required.
• Minimum of 1 year recent medical/surgical nursing experience required.
• Experience in Long Term and/or Acute Care Facility preferred
• Experience with MRDD patient and/or Public/Community Health preferred.
• Familiarity with EMR and computer applications (Word, Excel) preferred
• UAS certification also preferred.

I have read and understand my responsibilities.

Girling Health Care of New York