Job Title: Case Manager Job Location: Lincoln Immediate Supervisor:Senior Director Case MGMT-Hospital Programs Status: Non-Exempt JOB OVERVIEW Responsible for the collaborative team process which assesses, plans, implements, coordinates, monitors and evaluates the options and services to meet the patient’s health needs, using communication and available resources to promote quality, cost effective outcomes. These duties include the development of the patient’s overall plan of care including the identification, periodic review and revision, and communication of an individualized interdisciplinary plan of care. The case manager is accountable for meeting quality patient outcomes and service delivery based on (1) appropriate length of stay, (2) effective utilization of resources including program utilization, (3) continuity through a continuum of care, and (4) established standards. Additional responsibilities include serving as a liaison between patient, family, payor, team and physician; facilitation of education and training for patients, families and caregivers; for overall coordination of the patient’s program. The case manager must adhere to the CARF standards for a case manager. Work will be performed in an ethical and legal manner following organizational policies, processes, protocols and procedures. Responsible for quality service delivery and internal/external customer relations for Madonna as a whole, including upholding the mission and values for the department and facility. ESSENTIAL FUNCTIONS (INFORMATION) 1. Analyze patients past and current status, assesses impairments, disabilities and handicaps in order to plan, coordinate, implement and monitor an effective and efficient plan of care. 2. Analyze and monitor patient’s need for specialized tests, equipment, transportation, etc., in order to coordinate the provision of and payment for such services. 3. Monitor the patient’s current status as well as information in the medical record to evaluate and ensure the appropriate provision of care. 4. Compile and enter clinical data into E-rehab in order to facilitate program evaluation reporting and/or accurate reimbursement depending on program. 5. Assist in completing DRG validation to ensure accurate DRG assignment which drives reimbursement (for LTACH patients). 6. Analyze, assess and monitor patient’s financial information through the use of the Patient Based Income Statements (PBIS) and/or other sources in order to maximize appropriate utilization of resources. 7. Compile, coordinate and analyze patient’s program information in accordance with the requirements of third party payors in order to maximize appropriate utilization of patient’s financial benefits. 8. Coordinate and compile information regarding patient’s status and outcomes, unplanned discharges and patient follow-up to assess customer satisfaction, facilitate problem resolution, and contribute to evaluation of the program. 9. Compile and analyze information to monitor patient’s response to the current treatment plan, assess available, clinically and financially appropriate alternatives in order to plan and implement appropriate placement in the continuum of care. 10. Assist in compiling and analyzing patient, program and facility clinical and financial data in order to evaluate and improve patient outcomes, and maintain program viability. 11. Coordinate and compile patient information in order to ensure that discharge arrangements are completed and facilitate the implementation of discharge recommendations. (PEOPLE) 1. Mentor, negotiate, instruct and speak with patients and families in order to orient them to the program services, admission and discharge criteria and patient/family responsibilities in order to ensure patient/family active participation in the program. 2. Negotiate, instruct and speak with patients and families regarding financial information in order to maximize informed decision making. 3. Negotiate and speak with patients, families and other customers regarding concerns/grievances and facilitate resolution in order to ensure customer satisfaction. 4. Negotiate, instruct and speak with patients and families regarding discharge/transition arrangements in order to maximize patient outcomes, and appropriate utilization of the continuum of care. 5. Mentor, negotiate, instruct and speak with members of the interdisciplinary team in order to plan, implement, coordinate, monitor, evaluate and document the patient plan of care. 6. Mentor, negotiate, instruct and speak with members of the interdisciplinary team in order to monitor and resolve issues related to the plan of care in order to maximize customer satisfaction, patient/family participation and efficient, effective care delivery. 7. Negotiate, instruct and speak with interdisciplinary team and business staff regarding patient’s financial information in order to coordinate, monitor and evaluate appropriate program development, modification and efficient financial management. 8. Negotiate, instruct and speak with internal and external physicians and other service providers regarding patient’s progress, needs and program goals in order to coordinate and evaluate the program to maximize patient outcomes and/or responsible utilization of resources. 9. Negotiate, instruct and speak with third party payor representatives in order to develop contractual arrangements for services when necessary. 10. Negotiate, instruct and speak with external case managers regarding patient’s clinical program in order to coordinate and evaluate the program, maximize patient outcomes, and appropriate utilization of resources. 11. Negotiate, instruct and speak with interdisciplinary team and other stakeholders in order to ensure that discharge arrangements are complete and facilitate the implementation of discharge recommendations. 12. Negotiate, instruct and speak with team members, patients and families, and other stakeholders to coordinate follow up in order to ensure customer satisfaction. 13. Negotiate and speak with Case Management supervisor and/or Director of Case Management and other appropriate staff regarding difficult case situations and/or interdisciplinary team difficulties in order to assess, monitor and evaluate quality service delivery. 14. Instruct and speak with new department employees, team members, students and colleagues in order to recruit and retain a quality work force, and enhance the profession. 15. Follow instruction from the Case Management Supervisor, Director of Case Management and/or the administrative personnel to perform other functions as assigned in order to achieve the goals within the department and Madonna as a whole. 16. Negotiate with the Social worker to ensure Social Work functions are coordinated for continuity of care in the assigned Social Worker’s absence. PHYSICAL DEMANDS AND ENVIRONMENTAL CONDITIONS Physical requirements: Frequent sitting, standing and walking, occasionally lifting/carrying less than 10 pounds, frequently handling paper, pens, dictation equipment, telephone and personal computer. Frequently talking and hearing ordinary tones for conversational speech in person and on the telephone, frequently seeing handwritten and printed and on-screen material. Near vision acuity is required for reviewing medical records and documenting. QUALIFICATIONS Must be a Registered Nurse or a Bachelors Degree professional in an allied health area (social work, occupational therapy, physical therapy, speech pathology, rehabilitation counseling, etc.). Must have a minimum of 18 months clinical experience, one year of which must be in physical rehabilitation. Experience in medical case management or team facilitation preferred. General knowledge of Medicare and Medicaid programs and basic knowledge of indemnity and managed care insurance required. Knowledge of general rehabilitation principles, community resources and group dynamics required. Must possess effective skills in negotiation, group facilitation, conflict management, and consensus building. Must possess well developed written and verbal communication and problem solving skills. Must possess and maintain current licensure/ certification in area of clinical practice.