Case Management Specialist

JOB SUMMARY:

• Provides medically related Case Management to help patients in all areas of the hospital, attain and maintain the highest practical physical, mental and psychosocial well-being. The Case Management Specialist will identify the need for medically-related Case Management and pursue the provision of these services to establish appropriate discharge plans. Additionally, the Case Management Specialist will assist in facilitating insurance enrollment and ensuring patients understand their coverage options with an emphasis on interpreting insurance plans, educating patients on coverage details, and assisting with enrollment processes to promote access to care and financial security.

PRIMARY JOB DUTIES:

1. Adheres to Brodstone Healthcare’s Mission, Vision and Values.
2. Adheres to Brodstone Healthcare’s Standards of Behavior.
3. Conducts a patient, family and/or patient representative interview/Discharge Screen on all applicable patients.
4. Conducts Admission Process for patients admitted to Swing Bed services.
5. Coordinate discharge planning with other disciplines of patient service, patient, family and physician.
6. Assist as needed with arrangements for obtaining adaptive equipment, clothing or personal items for all patients.
7. Make referrals, obtain and arrange services from outside entities for all hospitalized patients as needed.
8. Assist with patient transfers to other facilities providing necessary information as needed.
9. Assists the patient and his/her family to understand the dynamics of the patient’s condition and necessary adjustments and provides supportive services.
10. Assist patients with financial, health insurance and legal matters as they are identified.
11. Assist with arrangements for identified or requested counseling services, support groups and treatment centers (i.e. drug or alcohol, grief, mental or physical health support groups).
12. Provide teaching on Advance Directives to patients, co-workers, families or public entities/groups as requested.
13. Receives and disseminates information on possible Swing Bed referrals to the appropriate departments (i.e. Utilization Review, PT, OT, ST, and provider).  Utilizing this information a collective decision can be made whether they qualify for Swing Bed admission or not.
14. Participate with other department directors in the development of overall policies and procedures in regards to Case Management.
15. Assume responsibility for statistical reports and recording of casework material.
16. Maintains and submits required records and associated reports.
17. Assist patients with insurance enrollment for Medicaid, Medicare, marketplace, and other available programs.
18. Interpret insurance plan documents to determine coverage, benefits, and limitations.
19. Educate patients and families on insurance benefits, terminology, and how to use their coverage effectively.
20. Screen patients for eligibility for various insurance programs and financial assistance.
21. Coordinate with social services and community resources to support uninsured or underinsured patients.
22. Serve as a liaison between patients, insurance companies, and hospital departments.
23. Track and follow up on pending insurance applications and verifications.
24. Stay current on insurance regulations and policy changes at the state and federal levels.
25. Provide one-on-one counseling to patients with complex insurance questions or concerns.
26. Identify trends or barriers in insurance access and report findings to leadership.
27. Develop and distribute educational materials about insurance options and enrollment processes.
28. Provide guidance and support for individuals seeking disability benefits, including assessing eligibility and facilitating applications.
29. Act as a liaison between patients/community members and external agencies to coordinate access to disability assistance and other supportive services.
30. Attends and participates in departmental meetings / in-services, Brodstone Healthcare’s quality improvement program, etc.
31. Performs other duties as assigned.

EDUCATION:

• Required
  • GED or High School Diploma
• Preferred
  • Associate Degree

EXPERIENCE:

• 1-2 Years Medical / Clinical experience 

CERTIFICATES, LICENSES, REGISTRATIONS:

• Required
  • Valid Driver's License
  • BLS within 90 days of hire
• Preferred
  • Social Services designation/certification with the first year of employment in Case Management

Join Brodstone Healthcare and have a lasting impact on Rural Nebraska!