CASE MANAGER-CASE MANAGEMENT

About the role

Case Manager is responsible for chart review to evaluate medical necessity for admission, continued stay, and the appropriate level of care. Monitors the care of assigned patients to assure quality, cost-effective utilization of resources and optimal outcomes. Coordinates the patient's plan of care from admission to discharge and/or transfer to another level of care.

Responsibilities

• Applies to individual case, through chart review, third payer regulations that govern admissions, continued stay, and discharge (e.g., IS/SI).
• Collects data related to clinical improvement initiatives for the purpose of developing action plans.
• Conducts concurrent chart reviews to assure complete and accurate medical records documentation.
• Coordinates the patient's plan of care with all members of the health care team including the patient, caregiver, and/or family members and case management.
• Demonstrates proficiency in patient assessment and documentation.
• Interviews and assesses patients to determine potential barriers to timely discharge/transfer to another level of care.
• Provides all payers with accurate, updated information.
• Obtains covered stay certification and prior authorization as appropriate.
• Refers cases when appropriate to physician advisor for medical necessity, continued stay, physician education, and appropriate level of care.
• Refers to Social Services when appropriate.
• Ensures discharge planning to the appropriate level of care, sub-acute, hospital units, and outpatient services.
• Supports hospital CQI programs by participation on relevant teams.
• Performs other duties as needed and/or assigned.

Requirements

• Knowledge of appropriate and timely return transition levels of care.
• Knowledge of CARF, Regulatory Agencies and State Board of Health, Long Term Care, Acute Care, and Ambulatory Care Standards.
• Demonstrates excellent interpersonal and problem-solving skills.
• Demonstrates self-directed, goal-oriented, and customer service focus.
• Excellent organizational and prioritization skills to meet deadlines.
• Capable of functioning effectively across service lines.
• Ability to assess and interpret data about the patient's status to identify each patient's age-specific needs and provide care for infants, children, adolescents, young adults, middle adults, and geriatric patients.
• Ability to independently perform comprehensive chart review with subsequent abstraction of relevant information, including interpretation of lab results, EKG, and other medical tests.
• Ability to communicate effectively both verbally and in writing.
• Ability to provide compassionate patient care oriented toward timeliness and accuracy in service delivery.
• Ability to respond positively to the needs of patients and families, addressing concerns privately, respectfully, and calmly.

Qualifications

• Active Licensed Registered Nurse.
• Basic Life Support Certification.
• 3 years of Acute Care experience (required).
• Associate's degree in Nursing (required).
• Bachelor's degree in Nursing (preferred).

All post-high school education must have been obtained from a recognized College or University.