Case Manager

About the Role

The Case Manager ensures patients, families, and guardians have access to special services that facilitate continuity of care post-discharge. This role oversees effective coordination of admission and discharge planning, case communications, interdisciplinary team meetings, insurance relations, and managed care systems. The Case Manager authorizes appropriate services for continued stay through discharge and ensures compliance with patient rights regulations. This position is considered safety-sensitive.

Responsibilities

• Conducts and documents a comprehensive initial assessment within 24 hours of admission to identify potential problems for the patient and/or family during admission and post-discharge, including:
  • Reason for admission and existing co-morbidities or conditions that increase readmission risk.
  • Patient’s ability to care for themselves at their current functional level, ensuring support systems are present.
  • Psychological and socioeconomic conditions.
• Gathers pertinent information from medical records and the interdisciplinary team.
• Leads and directs weekly interdisciplinary team meetings to establish attainable patient goals.
• Maintains comprehensive progress notes weekly and as needed.
• May assist the social worker in acquiring financial assistance for eligible patients.
• Collaborates with physicians regarding patient progress, expected outcomes, alternate levels of care, and updates to the treatment plan.
• Understands Medicare, Medicaid, insurance, and self-pay provisions and regulations.
• Ensures compliance with HIPAA and maintains computer and patient record security.
• Identifies high-risk families or situations for abuse or neglect and initiates appropriate referrals to social services, APS, and chaplain/ministerial services.
• Collects QI data for statistical purposes to aid in outcome measurement.
• Builds relationships and coordinates with payor sources to ensure proper reimbursement and promote cost-attentive care through resource management.
• Performs other duties as requested within the scope of practice.

Behavioral Standards

• Supports the mission, vision, and goals of Avem Health Partners and serves as a role model.
• Exhibits positive customer service behavior in daily interactions.
• Demonstrates a courteous and respectful attitude toward internal and external customers.
• Handles difficult situations discreetly and professionally.
• Holds self-accountable for professional practice.
• Interacts and copes effectively with diverse populations in stressful situations.
• Participates in performance improvement activities to support and improve patient care.
• Demonstrates knowledge of unit goals and actively participates in committees and projects.
• Stays current with literature regarding changing practices, interventions, and best practices in patient care.
• Seeks out educational and professional opportunities for personal growth and meets mandatory education requirements.
• Acts as a preceptor as requested.
• Demonstrates excellent work attendance and actively participates in meetings and training sessions.
• Adheres to the Avem Health Partners Code of Conduct and Standards of Behavior.
• Complies with established policies, procedures, and all health and safety requirements.

Requirements

• Graduate of an accredited school of nursing; BSN preferred.
• Three (3) years of case management experience.
• Current RN license from the State of Oklahoma Board of Nursing.
• Current BLS certification (or obtained within 30 days of hire).
• Certified Case Manager (CCM) certification preferred.

Physical Requirements

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made for individuals with disabilities upon request.

• Requires visual and auditory abilities to perform duties.
• Constant sitting is required.
• Frequent standing and walking is required.