Case Manager

The SRH Case Manager is responsible for coordinating services necessary for an organized, multidisciplinary approach to patient care. This role ensures quality, cost-effective care for rehabilitation patients by collaborating with healthcare providers, managing resources, and facilitating discharge planning.

Key Responsibilities

Care Coordination & Collaboration

• Work collaboratively with interdisciplinary teams, department members, and internal/external healthcare providers to enhance patient care and resource utilization.

• Coordinate needed services and ensure continuity of care by actively participating in all team conferences.

• Support physicians and clinical nurse coordinators in obtaining services, resolving issues, and maintaining access to accurate patient information.

Discharge Planning

• Develop individualized discharge plans based on patient and family needs, financial considerations, and interdisciplinary assessments.

• Ensure timely implementation of discharge activities and continuously update plans as patient needs change.

• Document discharge plans and all related actions in the medical record following departmental guidelines.

Rounds & Resource Management

• Lead or participate in weekly interdisciplinary rounds to confirm appropriateness of continued stay and progress toward goals.

• Oversee utilization management for assigned patients, including certifications, insurance benefits, scheduling outside appointments, and transportation needs.

Documentation & Compliance

• Maintain accurate, timely documentation in the medical record.

• Facilitate information exchange with agencies and facilities while adhering to confidentiality and legal requirements.

• Participate in departmental and team meetings as required.

• Monitor medical charts and nursing supervisor reports as needed.

Patient Advocacy

• Recognize patient rights related to effective pain management and collaborate with appropriate team members.

• Integrate cultural, spiritual, and ethical considerations into patient care planning.

Other Duties

• Perform other responsibilities as assigned to support effective case management operations.

Minimum Qualifications

Education

• Required: MSW in Social Science or BSN

• Preferred: MS or MSN

Experience

• Minimum of 2 years’ experience in a rehabilitation setting and/or discharge planning.

• Strong written and verbal communication skills.

Licenses & Certifications

• Required: LSW or LCSW

• Nursing candidates must hold appropriate state licensure if applicable.