CASE MANAGER SPECIALIST

About the role

Under the general supervision of the Care Progression Manager, acts as a Centralized Case Management Specialist to SSH&EC clients. Works in coordination with various care partners across the System to coordinate service or resources as routed to the Centralized Case Management Office.

Responsibilities

• Greets and acknowledges all patients and families in person or via telephone, with professionalism and directs to appropriate services.
• Acts as a positive role model to other staff, encouraging others to interact with customers, engage in conversation and express interest.
• Proactively greets customers by name and with individualized interest.
• Maintains a pleasant and professional office environment in keeping with Culture of Service Excellence standards.
• Answers telephones by the third ring, using department accepted greeting and in professional tone in accordance with the hospital’s telephone etiquette standards.
• Checks phone messages each hour and responds to call within same business day.
• Facilitates the scheduling of appointments when appropriate.
• Assists the care coordination clinical team with connecting patients and families to appropriate community resources.
• Calls to coordinate referrals to system and community programs.
• Facilitate the setup of ordered DME and/or home equipment to foster management of patients in the community when appropriate.
• Create referrals to Post-acute facilities and Homecare as directed by the RN Case Manager and Social Worker for discharge planning.
• Escalates any patient questions and / or concerns to the RN Case Manager as need arises.
• Escalate any provider concerns related to payer issues, or clinical concern to the RN Case Manager or Manager of Transitional Care.
• Speaks with Care Progression staff about proposed plan.
• Meets with patient and or designated contact to offer patient choice for Post-Acute vendors.
• Create referral for Post-Acute Acute Rehab, Skilled Nursing Facility, Homecare or other post-acute vendor.
• Communicate with Post-Acute vendor obtaining acceptance or denial of patient’s care and communicating this to the RN Case Manger or Clinical Social Worker.
• Maintain up to date communication with whole team.
• Maintain up to date documentation reflective of changes who, and why the changes were made in EMR.
• Uses SBAR to communicate with peers.
• Communicates effectively with closed loop communication techniques, always maintaining professional, polite and collegial tone and word choice.
• Maintains current working knowledge of resources available to client’s served via awareness of provider benefits for care choices, including public, private, and governmental payers and established / preferred ACO.
• Maintains current knowledge of care coordination resources within South Shore Health System.
• Maintains a working knowledge of the resources available in the community.
• Maintains a working knowledge of the requirements of the payers most frequently seen.
• Maintains a working knowledge of the established and preferred ACO relationships as defined in service area.
• Works independently to complete daily assignments by the end of the shift and long-term assignments by established deadline.
• Works independently with infrequent need for supervision.
• Informs supervisor when not able to meet deadline.
• Ability to connect with people and understand the challenges they face.
• Safety Awareness – Foster a “Culture of Safety” through personal ownership and commitment to a safe environment.
• Verifies the patient using two unique identifiers.
• Complies with the current CDC hand hygiene guidelines through proper handwashing, as observed by the nurse manager and peers.
• Makes appropriate use of personal protective equipment at all times.
• Adheres to universal precautions.

Qualifications

• Minimum Education - Preferred BS in Psychology, Social Work, Communications or health related field preferred.
• Minimum Work Experience 3-5 years recent healthcare experience or related field preferred.
• Experience working with patients and families, elders and their caregivers, and/or various other community populations desirable.
• Knowledge of community resources, eligibility and referral processes.
• Experience working with patients and families over the phone.
• Experience working in a team atmosphere.