Case Manager coordinates the overall interdisciplinary plan of care for patients, from admission to discharge. Monitors care and acts as a liaison between patient/family, healthcare personnel, and insurers. Being a Case Manager evaluates the needs of the patient, the resources available, and recommends and facilitates the plan for the best outcome. Develops a discharge plan that provides the best available resources to meet ongoing patient needs and that encourages compliance with medical advice. Additionally, Case Manager identifies patient care issues and suggests revisions to or new clinical pathways to improve quality of care. May also be responsible for conducting utilization reviews. Typically requires a bachelor’s degree of Nursing. Typically reports to a head of a department/unit. Requires Registered Nurse (RN). Case Manager’s years of experience requirement may be unspecified. Certification and/or licensing in the position’s specialty is the main requirement.
Case Manager Job Description Template
Our company is looking for a Case Manager to join our team.
Responsibilities:
- Conducts review for appropriate utilization of services. Evaluate patient satisfaction and quality of care provided;
- Ensure that patient tests are appropriate and necessary and are carried out within the established timeframe and that results are promptly available;
- Assist with insurance/funding issues to include, but not limited to, benefit termination, county funding and disability eligibility;
- Assist with medication issues as necessary;
- Provide service/support to specialized programming if/as necessary;
- Completes miscellaneous paperwork as needed to assist with discharge planning, acquisition of aftercare funding, and other requests;
- Completes documentation and communicates with schools, discharge planning, FMLA/STD, courts, and return to work letters;
- Performs continued stay reviews, authorizations, appeals, and pre-certifications;
- Complete expanded assessment of patients and family needs at time of admission. Complete psychosocial assessment/care plan;
- Introduces self to patient and family and explains clinical case manager role and process for patient and family to contact clinical case manager;
- Provide feedback to Program Management team with respect to program design, efficiency, efficacy and member/provider satisfaction;
- Responsible for the delivery of clinical and case management services to foster children, foster families, and biological parents;
- Other duties and responsibilities as assigned;
- Two yrs experience working with a medical group or IPA performing utilization review with managed care plans strongly preferred;
- Collaborate with Provider Relations, Market Management teams and Care Partner representatives in the management of members’ care plans.
Requirements:
- Foster family support;
- Develop structure/time management;
- Ability to manage effectively with or without subordinates;
- 1-2 years Substance/Addiction rehab experience required;
- Bachelor’s Degree in human services discipline, such as Psychology, Social Work, etc;
- Ability to exercise discretion regarding confidential information;
- Ability to work with a diverse spectrum of high-need individuals;
- Ability to work independently, and to conform to all applicable safety and accountability measures;
- Ability to engage in active listening—attending to what other people are saying and asking questions as appropriate;
- Apply common sense to carry out instructions furnished in written or oral form;
- Flexibility to provide coverage as needed, shifts would be between Monday-Friday between 8am-5pm;
- AA in a human or social services field, or combination of college and relevant experience;
- Ability to communicate in a clear and effective manner;
- Ability to report for work as scheduled on a consistent basis;
- Registered Nurse (RN) required.