The Case Manager is responsible for directing and coordinating the functions and activities of health care services delivery and discharge planning with the multidisciplinary team. The Case Manager facilitates communication and coordination between members of the health care team involving both the resident and family in the decision making process. Activities include encouraging appropriate use of health care services, as well as striving to improve quality of care and maintaining cost effectiveness on a case-by-case basis. The Case Manager is responsible for establishing a positive relationship with payer sources and initiating necessary documentation for re-authorization of the resident’s continued stay.
JOB SPECIFIC RESPONSIBILITIES:
• Assembles treatment team to conduct admissions conference with patient/resident and/or support persons.
• Assures a secure and comforting welcome to patient/residents support person upon admission.
• Contacts external payor source case manager/representative of the patient’s/resident’s actual admission and reviews schedule for clinical updates, upon resident’s admission,
• Completes Case Management Assessment of resident within 24 hours of admission or by the next business day.
• Liaison’s with the patient’s/resident’s attending physician and medical staff to ensure resident’s medical needs are met.
• Liaison’s with the Program Director and treatment team members to ensure patient’s/resident’s program and services of treatment accurately focused on resident’s deficits.
• Coordinates with the Program Director for weekly contact and documentation with payor sources and family/support persons of patient’s/resident’s.
• Coordinates with the multidisciplinary team and Program Director to develop patient’s/resident’s initial plan of care (master treatment plan) within 10 days of resident’s admission.
• Commutates with medical staff to receive medical updates and arrange for diagnostics, equipment, supplies or medical services as ordered.
• Provides third party payor sources with appropriate clinical documentation to assure re-certification
• Presents a positive and helpful working relationship with all external case managers/representatives and community agencies which demonstrates effective case management.
• Acquires appropriate information to address payor denials necessary to receive payment due.
• Maintains initial and ongoing documentation in the contact notes regarding patient’s/resident’s status, treatment progress, family issues, estimated length of stay and discharge needs.
• Utilizes MediTech for “clinical notes” for billing documentation as needed.
• Arranges proper and timely discharge planning for patients/residents in coordination with family or support persons.
• Coordinates input and feedback from the multidisciplinary team, patient’s/resident’s family, or support persons for discharge needs from admission to actual discharge.
• Identifies necessary community resources and verifies services are arranged to meet the patient’s/residents’ needs prior to discharge.
• Coordinates actual discharge with patients or resident’s family/support persons, payor sources and community services to ensure a safe, timely and effective discharge is achieved.
• Resolves patient’s/resident’s family or support person’s complaints or concerns to appropriate team member and follows up to ensure resolutions are acceptable to all parties.
• Exhibits professional positive demeanor to residents and relevant parties offering constructive communication, cooperation and assistance to ensure a satisfactory outcome of the patient’s treatment.
• Provides effective assistance and promotes positive relations with co-workers to achieve a collaborative team approach.
• Provides timely information/feedback to the designated supervisor on any patient or resident/family/support person/payor source issues that could jeopardize the resident’s treatment, positive outcomes or discharge planning issues.
• Completes verification of patient insurance by the 5th day of each month.
• Performs other duties as assigned.Apply Here »
Experience in case management
• Strong background in healthcare.
• 3-5 years direct patient care experience
Minimum Bachelor’s Degree in health care field required
• LVN or LMSW; RN Preferred