Care Manager

Job Description

Job Description

Job Responsibilities

• Daily review of Hospital and Skill Nursing Home inpatient list
• Case Review forms to UM / Quality Department by 4 : 00 PM New admissions
• Daily updates from Hospital and / or SNH Case Managers
• To provide information to Hospital and / or SNH Case Manager
• To coordinate post in patient admission services and office follow up
• To obtain medical records from Hospital and / or SNH for office follow up
• Family dynamics and support systems
• Coordinate with PCP and Care Team at Facilities any possible admissions and / or ER diversions to a Skilled Nursing Home
• Notify Skilled Nursing Home admitting physician and Case Manager of any possible admissions and provide medical information as needed
• Maintain appropriate documentation in available systems EMR and any other CM software
• Contact high risk patients when they are no shows.
• Document in the chart the reason and reschedule
• Regular interaction with office Care Team to review elective / future inpatient and outpatient procedures.
• Review w / PCP
• Review Pre-op clearance w / office staff
• Notify UM / Quality Department Director of upcoming inpatient procedures
• Review all out of the area admissions and keep a daily report
• Notify Medical Economics / Data Department of all out of area admissions
• Daily review of office schedules to identify any patients that need Case Management intervention.
• Recent Hospital / SNH discharges
• Disease Management
• Education on Advanced Directives, Community Services information
• Case Management System
• Maintain most current patients’ information
• Tracking system for Hospital / SNH admissions and Disease management
• To identify patients for Disease Management and follow up according to protocol
• CAD / CHF / COPD / DM / CKD Disease Management
• New patient orientation : All HMO Managed Care Advantage new members orientation within the 1st month of enrollment
• Completion of : Mini Mental, ADLs screening, psychosocial assessment (See new patient orientation form)
• Identification of any transfer for cause members or reallocation cases
• To maintain monthly logs

Job Qualifications

BENEFITS

FSA and Life Assistance Program (EAP)

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