Under the direction of the Manager, Clinical Resource Management; the Case Manager is responsible for the activities of utilization management, case coordination and the development and implementation of a discharge plan for an assigned group of patients. The Case Manager serves as a resource for other members of the healthcare team and provides education to team members on issues related to the continuum of care, reimbursement, regulatory agency guidelines and resource use. Through collaboration, the Case Manager assures that the treatment plan is implemented accurately, in a cost effective and efficient manner in order to promote customer satisfaction and prevent delays in care and discharge.
Responsible for reviewing severity of illness and intensity of service indicators to assure that appropriateness of care criteria is met. Documents reviews and discharge planning in the medical record and/or the computer system as appropriate; Collects and maintains data for tracking and reporting for outcome studies and performance improvement.
QualificationsEducation: Registered Nurse
Experience: 3 years of clinical experience. 1-year minimum experience in case manager role preferred.
Licenses, Certifications and/or Registrations: Current license, etc. required by the profession. Case Management Certification preferred, but not required.
Equipment/Tools/Work Aids: ICD-9 code book, computer, and software (including Star, Microsoft Word, Excel, Access, and Outlook), fax, copier and other office equipment.
Specialized Skills: Computer skills, effective communication skills (verbal and written), time management and critical thinking skills. Working knowledge of healthcare reimbursement, counseling, community resources, continuum of care and team building. Training in patient assessment home care planning and criteria review.
Physical Requirements: Ability to communicate verbally and in writing. Ability to assist in moving, lifting, pulling, pushing equipment with a minimum of 30 pounds. Ability to push/pull (75-100 lbs.) medical record cart. Ability to meet attendance requirement of the job. Moderate amount of daily walking and standing. Manual dexterity necessary for typing, writing and manipulation of a mouse; Routine bending, stooping, squatting and overhead use of arms.
