Case Manager Care Coordination

Position Summary

This position provides comprehensive care coordination for patients as assigned. The intensity of care coordination provided is situational and appropriate based on patient need and payer requirements. This position is accountable for the clinical quality of Care Coordination services delivered by both them and others and identifies/resolves barriers which may hinder effective patient care.

Core Functions

• Manages individual patients across the health care continuum to achieve the optimal clinical care, financial, operational, and satisfaction outcomes.
• Acts in a leadership function with process improvement activities for populations of patients to achieve the optimal clinical, financial, operational, and satisfaction outcomes.
• Acts in a leadership function to collaboratively develop and manage the interdisciplinary patient discharge plan.
• Effectively communicates the plan across the continuum of care.
• Maintains knowledge of Medicare, Medicaid and other program benefits to assist patients with discharge planning and choices.
• Knowledge of community resources relevant to health care, end of life dynamics, substance abuse, abuse, neglect, and domestic violence.
• Establishes and promotes a collaborative relationship with physicians, payers, and other members of the health care team.
• Collects and communicates pertinent, timely information to payers and others to fulfill utilization and regulatory requirements.
• Educates internal members of the health care team on case management and managed care concepts.
• Facilitates integration of concepts into daily practice.
• May supervise other staff.

Minimum Qualifications

• RN: Must possess knowledge of case management or utilization review as normally obtained through the completion of a bachelor's degree in case management or health care. Requires current Registered Nurse (R.N.) license in state worked.
• Social Worker: Requires a Master's Degree in Social Work. Requires a Licensed Master Social Worker (LMSW) (equivalent*) or Licensed Clinical Social Worker (LCSW) or have a MSW with the requirement to become licensed within 6 months of hire date. An equivalent license applies to states that do not recognize an LMSW; therefore, the employee must possess a Master’s Degree and be a Licensed Social Worker. For assignments in an acute care setting, Basic Life Support (BLS) certification is also required. Requires a proficiency level typically achieved with 2 years clinical experience.

Additional Related Education And/or Experience

• Certification for CCM (Certified Case Manager) preferred.