JOB TITLE: Case Manager
REPORTS TO: Administrator
FLSA STATUS: Non-Exempt
JOB OVERVIEW: The case manager position is focused on managing the components of care
for patients within the continuum of care, with the goals of achieving quality care outcomes and
financial appropriateness. The case manager oversees the process of care delivered to the patients,
collaborates with the interdisciplinary team , provides leadership to the healthcare team , and is
committed to the organizations' goals for professional case management services. The case
manager is often referred to as the "captain of the ship" as their role is designed to provide both
leadership and management to the patient's care plan. They are the coordinators of patient care
delivery, as well the patient advocate, and quality and cost experts of the healthcare team.
Case managers monitors and manages clinical and financial coordination of the care plan of the
assigned patients to ensure timely, cost- effective, individualized service delivery. Works with
rehabilitation patients with various disabilities including, but not limited to spinal cord injury, brain
injury, cerebrovascular accident, amputation, neurologic disorders, orthopedic conditions, and
arthritis. Coordinates length of stay management within Medicare (CMS) guidelines and 60%
compliance threshold.
CASE MANAGEMENT KEY RESPONSIBILITIES
1. Length of Stay Management
2. Documentation
3. Team Conference
4. Insurance Reauthorization for Continued Stay
5. QIO Process- Important Message from Medicare and Detailed Notice of Discharge
when a patient appeals their discharge plan.
6. eRehab Outcomes System
ESSENTIAL FUNCTIONS INCLUDE BUT ARE NOT LIMITED TO:
a. Provide care team management, leadership, and coordination
b. Meets with patient upon admission to discuss rehabilitation process and role of
case manager.
c. Conducts and documents initial patient assessment within 72 hours, to include
psychosocial, clinical, and family and disposition status; determines tentative
initial discharge plans in conjunction with patient and family goals.
d. Involves the patient/family in the development of the plan of care by obtaining
their goals for rehabilitation.
e. Reviews goals with patient's family (with patient's permission) and third-party
payer.
f. Oversees the patient's plan of care while the patient is receiving care
g. Provides frequent reassessments and evaluations of patient care received.
h. Collaborates and facilities needed changes to the plan of care.
i. Coordinates, evaluates, documents and reviews interdisciplinary team goals as
they pertain to the plan of care and discharge plan.
j. Ensures that the care plans are appropriate for patients and coordinates treatment
planning with the patient's insurance provider or other payors.
k. Works with CMGs as well as utilization review methods and tools to guide
appropriate patient care. Rev.9/2022
l. Evaluates the interventions of the patient care interdisciplinary team related to
established cost and quality care goals.
m. Works closely with payor sources to oversee plan benefits for patients.
n. Assist and advises the organization in the development of policies and procedures
that will guide safe and effective quality of care outcomes.
o. Participates on quality-of-care reviews within the organization and with outside
agencies.
p. Coordinates team conferences.
q. Documents in the medical record a summary of the team conference.
r. Participates on quality-of-care committees and is an active participant in the
development of quality-of-care initiatives.
s. Educates members of the interdisciplinary care team on issues related to cost and
cost containment, as well as the benefits plans for patients.
t. Communicates the results of any identified research projects related to patient
outcomes as well as regulatory updates that supports evidence-based practices in
healthcare.
u. Oversees that unnecessary health care cost and over utilization are avoided.
v. Ensures the ethical and legal issues related to patient care delivery are addressed and
that care is provided appropriately.
w. Serves as the primary family contact (with patient permission) for the treatment
team, communicating within 48 hours of the team conference. Also updates the
external case manager and/or payer source regarding progress, plan, and patient's
future needs (as requested by payer source).
x. Ensures the scheduling of family conferences, family participation in therapy and
provides pertinent information to appropriate team members.
y. Coordinates all discharge activities to include patient equipment requirements
completion of discharge plans, coordinating post -discharge information to the
family and receiving facility, coordinating the arrangements for family
education, and other post-discharge services as appropriate for patient
discharge level of care.
z. Calls patient or family as needed post-discharge to ensure planned discharge
recommendations are occurring and to assess if additional services are needed.
aa. In collaboration with the CFO , monitors and ensures needs of per diem
negotiations, recertification, concurrent reviews, and timely reports.
bb.Participates in monitoring, analyzing, and utilizing program evaluation data to
promote quality of care and position hospital for success.
cc. Works closely with finance to facilitate Utilization Management program.
Resources for review: Conditions of Participation Discharge Planning ( A-0799-A-0843)
Policy and Procedure: Patient Discharge Planning ( CM. 2.12.1)
Rev. 9/2022
Knowledge, Skills, and Abilities:
• Language Skills: Able to communicate effectively in English, both verbally and in
writing.
• Skills: Basic computer knowledge
Education and Experience:
• Current Louisiana Licensure as an LPN or RN. Fifth year college or university program
certificate; or two to four years related experience and/or training; or equivalent
combination of education and experience. Knowledge of basic bookkeeping, office
procedures, and electronic billing procedures. BCLS - required.
OSHA:
I-Position is considered to have opportunity for routine exposure to blood borne pathogens in
the normal performance of job duties.
II- Position is considered to have occasional opportunity for exposure to blood borne
pathogens in the normal performance of job duties.
III-Position is considered to have no occupational exposure to blood borne pathogens in the
normal performance of job duties.
PHYSICAL DEMANDS:
The physical demands described here are representative of those that must be met by an employee
to successfully perform the essential functions of this job. Reasonable accommodations may be
made to enable individuals with disabilities to perform the essential functions.
While performing the duties of this Job, the employee is regularly required to sit with intermittent
standing, walking, crouching. Requires use hands to finger, handle, or feel; reach with hands and
arms and talk or hear. May require occasional lifting of up to 20 pounds.
A review of this position description may have excluded some of the marginal functions of the
position that are incidental to the performance of fundamental job duties. This position description
in no way states or implies that these are the only duties to be performed by the employee in this
position. Employees will be required to follow any other job-related instructions and to perform
any other job-related duties requested by their supervisors.
I acknowledge that my employment relationship with United Medical Rehabilitation Hospital,
unless otherwise provided in writing, shall be defined as "employment at will," where either party
may dissolve the relationship at any time.
I have reviewed this job description and understand that it is my responsibility to perform up to
the high standards set forth by United Medical Rehabilitation Hospital.
Employee Signature:
Date:
UNITED MEDICAL REHABILITATION HOSPITALS IS AN EQUAL OPPORTUNITY EMPLOYER