Case Manager - Full-Time

Description

The Case Manager is responsible for directing and coordinating the functions and activities of health care services delivery and discharge planning with the multidisciplinary team. The Case Manager facilitates communication and coordination between the health care team members involving both the resident and family in the decision-making process. Activities include encouraging appropriate use of health care services, improving quality of care, and maintaining cost-effectiveness on a case-by-case basis. The Case Manager is responsible for establishing a positive relationship with payer sources and initiating necessary documentation to re-authorize the resident’s continued stay.

• Assembles treatment team to conduct admissions conference with patient/resident and/or support persons.
• Assures a secure and comforting welcome to patient/residents support person upon admission.
• Contacts external payor source case manager/representative of the patient’s/resident’s actual admission and reviews schedule for clinical updates, upon resident’s admission,
• Completes Case Management Assessment of the resident within 24 hours of admission or by the next business day.
• Liaison’s with the patient’s/resident’s attending physician and medical staff to ensure the resident’s medical needs are met.
• Liaison’s with the Program Director and treatment team members to ensure the patient’s or resident’s program and treatment services accurately focused on the resident’s deficits.
• Coordinates with the Program Director for weekly contact and documentation with payor sources and family/support persons of patient’s/resident.
• Coordinates with the multidisciplinary team and Program Director to develop patient’s/resident’s initial plan of care (master treatment plan) within ten days of resident’s admission.
• Commutates with medical staff to receive medical updates and arrange for diagnostics, equipment, supplies, or medical services as ordered.
• Provides third party payor sources with appropriate clinical documentation to assure re-certification
• Presents a positive and helpful working relationship with all external case managers/representatives and community agencies, demonstrating effective case management.
• Acquires appropriate information to address payor denials necessary to receive payment due.
• Maintains initial and ongoing documentation in the contact notes regarding patient’s/resident’s status, treatment progress, family issues, estimated length of stay, and discharge needs.
• Utilizes Meditech for “clinical notes” for billing documentation as needed.
• Arranges proper and timely discharge planning for patients/residents in coordination with family or support persons.
• Coordinates input and feedback from the multidisciplinary team, patient’s/resident’s family, or support persons for discharge needs from admission to actual discharge.
• Identifies necessary community resources and verifies services are arranged to meet the patient’s/residents’ needs before discharge.
• Coordinate actual discharge with patients or residents’ family/support persons, payor sources, and community services to ensure a safe, timely, and effective discharge.
• Resolves patient’s/resident’s family or support person’s complaints or concerns to appropriate team members and follows up to ensure resolutions are acceptable to all parties.
• Exhibits a positive professional demeanor to residents and relevant parties, offering constructive communication, cooperation, and assistance to ensure satisfactory patient treatment.
• Provides effective assistance and promotes positive relations with co-workers to achieve a collaborative team approach.
• Provides timely information/feedback to the designated supervisor on any patient or resident/family/support person/payor source issues that could jeopardize the resident’s treatment, positive outcomes, or discharge planning issues.
• Completes verification of patient insurance by the 5th day of each month.
• Performs other duties as assigned.

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Job Requirements

Experience

• Experience in pediatric case management 
• Strong background in healthcare
• 3-5 years direct pediatric patient care experience

Education Required

• Bachelor’s Degree in health care field preferred

Additional Information

LICENSURE/CERTIFICATION:

• LVN or LMSW; RN Preferred 
• Current AHA BLS certification.