What are the responsibilities and job description for the Case Manager position at United Medical Healthwest Rehabilitation Hospital?
JOB TITLE: Case Manager
REPORTS TO: Administrator
FLSA STATUS: Non-Exempt
JOB OVERVIEW: In collaboration with the physician provides individual program
management for each patient to ensure the patient's progression through the continuum of care in
a manner that achieves the desired clinical and financial outcomes. Monitors and manages
clinical and financial coordination of treatment plan of 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.
ESSENTIAL FUNCTIONS INCLUDE BUT ARE NOT LIMITED TO:
a. Meets with patient upon admission to discuss rehabilitation process and role of
case manager.
b. Conducts and documents initial patient assessment within 72 hours, to include
psychosocial, family and disposition status; determines tentative initial discharge
plans in conjunction with patient and family goals.
c. Appropriately modifies approach to the patient based upon patient's age and
developmental level.
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. Maintains accurate up-to-date documentation in the medical records of patient and
family contacts, communications with payers and other services performed on
behalf of patient and family.
g. Coordinates, evaluates, documents and reviews interdisciplinary team goals as
they pertain to the plan of care and discharge plan.
h. Coordinates team conferences.
i. Documents in the medical record a summary of the team conference.
j. 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).
k. Ensures the scheduling of family conferences, family participation in therapy and
provides pertinent information to appropriate team members.
l. Documents in the medical record a summary of the family conference.
m. Coordinates completion of discharge plans by assisting with arrangements for
family education, equipment and services as appropriate for patient discharge
level of care.
n. Calls patient or family as needed post-discharge to ensure planned discharge
recommendations are occurring and to assess if additional services are needed.
o. In collaboration with the Controller, monitors and ensures needs of per diem
negotiations, recertification, concurrent reviews and timely reports.
p. Participates in monitoring, analyzing and utilizing program evaluation data to
promote quality of care and position hospital for success.
q. Works closely with finance in order to facilitate Utilization Management
program.
r. Maintains good working relationships with other hospital departments,
participates in hospital meetings and serves on hospital committee as requested.
Knowledge, Skills and Abilities:
ï?· Language Skills: Able to communicate effectively in English, both verbally and in
writing.
ï?· Skills: Basic computer knowledge
Education and Experience:
ï?· Current Louisiana Licensure as 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
REPORTS TO: Administrator
FLSA STATUS: Non-Exempt
JOB OVERVIEW: In collaboration with the physician provides individual program
management for each patient to ensure the patient's progression through the continuum of care in
a manner that achieves the desired clinical and financial outcomes. Monitors and manages
clinical and financial coordination of treatment plan of 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.
ESSENTIAL FUNCTIONS INCLUDE BUT ARE NOT LIMITED TO:
a. Meets with patient upon admission to discuss rehabilitation process and role of
case manager.
b. Conducts and documents initial patient assessment within 72 hours, to include
psychosocial, family and disposition status; determines tentative initial discharge
plans in conjunction with patient and family goals.
c. Appropriately modifies approach to the patient based upon patient's age and
developmental level.
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. Maintains accurate up-to-date documentation in the medical records of patient and
family contacts, communications with payers and other services performed on
behalf of patient and family.
g. Coordinates, evaluates, documents and reviews interdisciplinary team goals as
they pertain to the plan of care and discharge plan.
h. Coordinates team conferences.
i. Documents in the medical record a summary of the team conference.
j. 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).
k. Ensures the scheduling of family conferences, family participation in therapy and
provides pertinent information to appropriate team members.
l. Documents in the medical record a summary of the family conference.
m. Coordinates completion of discharge plans by assisting with arrangements for
family education, equipment and services as appropriate for patient discharge
level of care.
n. Calls patient or family as needed post-discharge to ensure planned discharge
recommendations are occurring and to assess if additional services are needed.
o. In collaboration with the Controller, monitors and ensures needs of per diem
negotiations, recertification, concurrent reviews and timely reports.
p. Participates in monitoring, analyzing and utilizing program evaluation data to
promote quality of care and position hospital for success.
q. Works closely with finance in order to facilitate Utilization Management
program.
r. Maintains good working relationships with other hospital departments,
participates in hospital meetings and serves on hospital committee as requested.
Knowledge, Skills and Abilities:
ï?· Language Skills: Able to communicate effectively in English, both verbally and in
writing.
ï?· Skills: Basic computer knowledge
Education and Experience:
ï?· Current Louisiana Licensure as 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