Case Manager

Position Summary

Using discretion and independent judgment, the Case Manager is responsible for all case management activities assigned. This includes case management and utilization management. The Case Manager provides concise management of patients’ hospitalization from pre-admission through discharge in the areas of patient care, fiscal management, and Payor/referral satisfaction. The Case Manager is responsible for conducting Discharge Planning Evaluations, performing discharge planning to ensure patients and their families receive maximum benefits, and awareness of community and government agencies.

Responsibilities

• Have an understanding of the commercial insurance appeal process.
• Have a working knowledge of billing ad reimbursement and letter of agreement.
• Be knowledgeable regarding pre-certification and concurrent review process.
• Must have clear and concise professional language in the preparation of up to date clinical reports representing the patient’s total condition and treatment plan.
• The Lead Case manager, Director of Case Management or a department representative will participate in a brief portion of the hospital liaison/ marketing meeting to share positive and challenging case-specific, case type, or data-based outcomes.
• Routine participation allows for a positive exchange of information between the departments to identify high risk factors that could potentially affect the outcome of future admissions.
• Have working knowledge of Federal and State Regulatory Compliance.
• Be responsible to document case-based activities with treatment plan/ discharge plan interventions.
• As the designated team leader, have a good working knowledge and ability to facilitate interdisciplinary team conference identifying clinical challenges and outstanding issues.
• Able to discharge patients successfully without adverse health consequences with all needs identified.

Qualifications

This position requires a MSW or LCSW with at least three (3) years of work experience in a medical case management setting. Exceptions are made with CEO approval. Good organizational and liaison capabilities with well-developed written and verbal communication abilities are required. Well demonstrated public relations skills with a cooperative and assertive attitude. Working knowledge of the insurance industry is required.