Case Manager

Case Manager

JOB SUMMARY

The case manager is responsible for the development of a comprehensive and goal oriented plan of care as it relates to providing ongoing psychosocial assessment, screening for potential needs, discharge planning, and communication with the clinical team and professional staff; Acting as a liaison between the patient, the clinical team, and utilization manager; the management of individual caseloads of patients through interaction with families, conducting weekly interdisciplinary team meetings and assisting patients and families with discharge planning; supporting the case management department needs by functioning as a utilization manager as needed.

ESSENTIAL FUNCTIONS

PATIENT / CUSTOMER

Essential Accountabilities

Ensures communication and collaboration with supervisors and fellow co-workers to serve patients and other customers to the best of his / her ability.

Is professional in all actions and appearance

Anticipates patients’ / customers’ needs and acts accordingly.

Works to enhance patient satisfaction

Analyzes problems from the customers’ point of view.

Honors patient / customer / employee confidentiality.

Seeks feedback on how to improve performance and offers constructive feedback, as well.

Assist patients and families

Applies learning for improved performance.

Demonstrates understanding and ownership of how his / her role contributes to achieving the success of the Department and GSPP.

Demonstrates a personal commitment to ensuring a clean and safe working environment.

Uses resources wisely – as if they were one’s own.

Non-Essential Accountabilities

Strives to understand and value differences in others’ race, nationality, gender, age, background, experience, and style.

Assists in orienting new employees / staff, if / as needed.

Attends staff meetings and continuing education in-service training as directed by supervisor.

PATIENT / EMPLOYEE SAFETY ACCOUNTABILITIES

Non-Patient Care

Participates in GSPP and Department wide initiatives for Patient / Employee safety

Demonstrates an awareness of patient / employee safety when carrying out daily responsibilities of their position.

Patient Care Providers

Participates in GSPP and Department wide initiatives for Patient / Employee safety

Demonstrates an awareness of patient / employee safety when carrying out daily responsibilities of their position.

Validation of annual competencies required for the position

OPERATIONS

Responsible for planning, organizing and evaluating interventions and their effect on the discharge outcome.

Lead weekly team conferences to coordinate patient care and discharge planning with the interdisciplinary team. Document as appropriate in EMR platform.

Initial and ongoing psychosocial assessment to identify potential discharge needs and develop a discharge plan. Ascertains patient’s medical, psychological, emotional, and social needs are obtained and addressed by the interdisciplinary team.

Documentation of admission in appropriate EMR platforms.

Prepare the patient and the family for discharge. Ensures family education is completed prior to discharge.

Establish family conferences as needed / required.

Provide patients / families with information regarding choice of next level of care.

Arrange for post-discharge services : home health care services, durable medical equipment delivery, access to medications, skilled nursing placement, referrals to community resources. etc.

Work with case management team to improve the awareness of resources available to support the transition of patients into their community.

Arrangements for transportation at the time of discharge, and continued in the community setting.

Inform patients of their rights under CMS / Medicare guidelines.

Promote utilization of available resources to achieve cost effective outcomes.

Maintains current knowledge of regulations affecting utilization management and utilization review.

Facilitates educational programs and advises physicians, and other departments, or regulations affecting discharge planning process Provides utilization management coverage for utilization manager during times of SPTO / USPTO as necessary.

QUALIFICATIONS

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and / or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education

Bachelor's Degree in Nursing or Social Work required

Master's Degree preferred

Work Experience

3-5 years of relevant case management experience required

Previous experience in utilization review preferred

Licenses / Certifications

Registered Nurse license required OR

LSW / LCSW, and / or Certified Case Manager (CCM) preferred

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