Case Manager II

About the Role

Coordinates and facilitates the care of the patient population through effective collaboration and communication with the Interdisciplinary Care Transitions (ICT) team members. Follows patients throughout the continuum of care to ensure optimum utilization of resources, service delivery, and compliance with external review agencies. Provides ongoing support and expertise through comprehensive assessment, care planning, plan implementation, and overall evaluation of individual patient needs. Enhances the quality of patient management and satisfaction, promoting continuity of care and cost effectiveness through the integration of case management, utilization review, and discharge planning functions.

Responsibilities

• Coordinates clinical and/or psycho-social activities with the Interdisciplinary Team and Physicians.
• Monitors all areas of patients’ stay for effective care coordination and efficient care facilitation.
• Remains current on reimbursement modalities, community resources, case management, psychosocial, and legal issues affecting patients and care providers.
• Appropriately refers high-risk patients who would benefit from additional support and serves as a patient advocate.
• Enhances collaborative relationships to maximize the patient’s and family’s ability to make informed decisions.
• Demonstrates knowledge of growth and development principles over the life span and provides age-appropriate care.
• Participates in interdisciplinary patient care rounds and/or conferences to review treatment goals, optimize resource utilization, provide family education, and identify post-hospital needs.
• Collaborates with clinical staff in developing and executing the plan of care and achieving goals.
• Coordinates with the interdisciplinary care team, physicians, patients, families, post-acute providers, payors, and others in planning care throughout the continuum.
• Performs other related duties as assigned.

Requirements

• Postsecondary (Cert/Diploma/Program Grad) from an accredited school of nursing (Required).
• Bachelor’s Degree in nursing or social work: BSN, MSN, BSW, or MSW (Preferred).
• RN - Registered Nurse - State Licensure and/or Compact State Licensure in the state of practice (Required).
• LCSW - License Clinical Social Worker (LCSW or LSW) (Required).
• CSWCM - Social Work Case Manager Certification (Preferred).
• 2+ years of experience in a healthcare setting (Required).
• Prior experience in case management, utilization review, or discharge planning (Preferred).
• Must read, write, and speak fluent English.
• Good and regular attendance.

Skills

• Knowledge of government and non-government payor practices, regulations, standards, and reimbursement.
• Knowledge of Medicare benefits, insurance processes, and contracts.
• Knowledge of accreditation standards and compliance requirements.
• Critical thinking, prioritization, and time management skills.
• Basic computer skills with proficiency in Microsoft Office, word-processing, and spreadsheet software.
• Excellent interpersonal, verbal, and written communication skills.
• Good interpersonal skills when interacting with patients, families, and staff.