What are the responsibilities and job description for the Care Manager/ Case Manager position at Good Shepherd Rehabilitation Network?
JOB SUMMARY
Develops an integrated link between patients, families, local resources, insurance representatives and hospital, enhances communication among these parties to assure appropriate and timely utilization and access to services and exchange of information, therapeutic interventions and advocates for the rights and needs of patients.
ESSENTIAL FUNCTIONS
ASCERTAINS PATIENT’S MEDICAL, PSYCHOLOGICAL, EMOTIONAL AND SOCIAL NEEDS
By interviewing patient, completing initial care management assessment, screening for potential discharge planning needs, communicating with treatment team.
DEVELOPS THERAPEUTIC INTERVENTION PLAN ACCORDING TO NEEDS
By exploring options, setting goals, establishing rapport with patient and significant others.
OBTAINS SERVICES AND RESOURCES FOR PATIENT
By ascertaining appropriateness and referring to community resources
Establishing rapport with agencies and support groups
Arranging appointments
REPRESENTS RIGHTS AND NEEDS OF PATIENTS
By educating and informing patients about their rights
Advocating on their behalf with community resources, insurers, treatment team
COORDINATES TREATMENT AND DISCHARGE PLAN
By leading interdisciplinary team meetings
Bridging communication between team members, ancillary departments, insurers and significant others.
MAINTAINS DOCUMENTATION
By appropriate and timely notations in the medical record, departmental files, hand-off communication documents (i.e. POD report), electronic documentation systems and databases.
ADDRESSES PATIENT SAFETY
By identifying and communicating patient safety issues to the team, patient/family
Relaying recommendations for a safe discharge plan to patient/family
Assisting to resolve care issues by making referrals to address identified needs
Reporting to regulatory agencies as required, facilitating appropriate utilization of services.
Coordinates UTILIZATION MANAGEMENT ProcessES
By reviewing clinical information based upon admission and continued stay criteria
Performing concurrent medical reviews to communicate to payers
Initiating physician advisor reviews for cases not meeting established criteria for admission and/or continued stay to facilitate appropriate utilization of services
Communicating denials from third party payers to the physician and coordinating a timely appeals process
Updating demographic information,
Obtaining signatures on admission paperwork and/or advance directives forms (where applicable)
DEMONSTRATES A PROFESSIONAL DEMEANOR AND MAINTAINS PROFESSIONAL KNOWLEDGE
By being flexible, responding positively to unexpected changes in the work load and work hours
Performing other duties as directed
Keeping abreast of regulations and policies related to utilization management and discharge planning, departmental staff meeting information.
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 required
Master's Degree preferred
Work Experience
1-2 years of related experience required
Licenses / Certifications
Clinical license in appropriate discipline preferred.
Hourly Wage Estimation for Care Manager/ Case Manager in Center, PA
$44.00 to $53.00
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