Care Manager II - Case Management
Description Summary
The Care Manager (CM) II collaborates with the patient/family, physicians, and multidisciplinary team members to ensure patient progression through the continuum of care and to develop a plan of care. This role coordinates patient care progression, supports discharge planning, and ensures regulatory compliance.
Responsibilities
Coordinates case management functions into patient care and discharge planning processes.
Serves as a resource, providing support, and advocating for the patient related to treatment decisions and end-of-life issues.
Maintains patient length of stay and collaborates with interdisciplinary team members to expedite discharge.
Implements and monitors the patient's plan of care to ensure effectiveness and appropriateness of services.
Identifies and escalates barriers to diagnostic or treatment progress and issues related to quality and risk.
Collaborates with medical staff, nursing staff, and ancillary staff to eliminate barriers to efficient delivery of care.
Interviews patients/families to assess social, emotional, and financial factors impacting health status.
Develops comprehensive discharge planning assessments and care plans, including referrals for rehabilitation, nursing home, psychiatric, substance abuse, dialysis, child/adult/domestic abuse, home health/hospice, legal issues, advance directives, DME referrals, and community resources.
Ensures plan consensus from patient/family, physician, and payor, and educates and supports patients and families in achieving their goals of care.
Provides information and support to patients and families, helping them access resources within the medical center and community.
Participates in clinical performance improvement activities and measures effectiveness of interventions.
Escalates cases as appropriate and per policy to Physician Advisors and/or CM Director.
Documents in the medical record per regulatory and department guidelines.
Qualifications
Graduate of an accredited school of nursing (BSN preferred) or Master’s Degree in Social Work (MSW) required or demonstrated success in CHRISTUS Care Manager I position for at least 5 years on top of the required experience in lieu of education.
Two or more years clinical experience with one year in the acute care setting preferred.
RN or LMSW in the state of employment is required for new hires. LBSW accepted for associates with 5+ years of demonstrated success and experience in CHRISTUS Care Manager I role.
Certification in Case Management preferred.
BLS preferred.