Care Manager/ Case Manager

Job Title

Develops an integrated link between patients, families, local resources, insurance representatives and hospital, enhances communication among these parties to assure appropriate and timely utilization and access to services and exchange of information, therapeutic interventions and advocates for the rights and needs of patients.

Essential Functions

• Ascertains patient's medical, psychological, emotional and social needs
  • By interviewing patient, completing initial care management assessment, screening for potential discharge planning needs, communicating with treatment team.
• Develops therapeutic intervention plan according to needs
  • By exploring options, setting goals, establishing rapport with patient and significant others.
• Obtains services and resources for patient
  • By ascertaining appropriateness and referring to community resources
  • Establishing rapport with agencies and support groups
  • Arranging appointments
• Represents rights and needs of patients
  • By educating and informing patients about their rights
  • Advocating on their behalf with community resources, insurers, treatment team
• Coordinates treatment and discharge plan
  • By leading interdisciplinary team meetings
  • Bridging communication between team members, ancillary departments, insurers and significant others.
• Maintains documentation
  • By appropriate and timely notations in the medical record, departmental files, hand-off communication documents (i.e. POD report), electronic documentation systems and databases.
• Addresses patient safety
  • By identifying and communicating patient safety issues to the team, patient/family
  • Relaying recommendations for a safe discharge plan to patient/family
  • Assisting to resolve care issues by making referrals to address identified needs
  • Reporting to regulatory agencies as required, facilitating appropriate utilization of services.
• Coordinates utilization management processes
  • By reviewing clinical information based upon admission and continued stay criteria
  • Performing concurrent medical reviews to communicate to payers
  • Initiating physician advisor reviews for cases not meeting established criteria for admission and/or continued stay to facilitate appropriate utilization of services
  • Communicating denials from third party payers to the physician and coordinating a timely appeals process
  • Updating demographic information,
  • Obtaining signatures on admission paperwork and/or advance directives forms (where applicable)
• Demonstrates a professional demeanor and maintains professional knowledge
  • By being flexible, responding positively to unexpected changes in the work load and work hours
  • Performing other duties as directed
  • Keeping abreast of regulations and policies related to utilization management and discharge planning, departmental staff meeting information.

Qualifications

• To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
  • Education
    • Bachelor's Degree required
    • Master's Degree preferred
  • Work Experience
    • 1-2 years of related experience required
  • Licenses / Certifications
    • Clinical license in appropriate discipline preferred.