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.
- Essential Accountabilities
- 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
- Non-Patient Care
- 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.
- PATIENT / CUSTOMER
- 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
- Education
- 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.