Case Manager

Summary & Objective

The Case Manager coordinates discharge planning for residents and / or patients and helps manage their healthcare and social service needs by acting as a liaison between them and the physicians and nurses as related to their progress and status while in the facility. The Case Manager also assists residents and / or patients in getting access to community resources and programs.

Essential Functions

• Interviews resident and / or patient and completes assessment within 72 working hours and documents in Medical Record.
• Obtains timely insurance re-certifications and provides weekly updates verbal / written for continued stay authorization and enters into billing software.
• Attends interdisciplinary team conference to discuss resident and / or patient status.
• Conducts family conference meetings as needed.
• Discharge planning to the community with but not limited to home health durable medical equipment outpatient services referrals Long Term Care Assisted Living Facility and Skilled Nursing Facility.
• Educates with patient and / or family of advanced directives if applicable
• Educates community resources and programs to patient and / or family.
• Coordinates and obtains authorization from insurance company for all procedures appointments and transportation for all HMO residents and / or patients.
• Communicates with patient and / or responsible party when person served is approaching the end of rehabilitative care status and interprets recommendations for continuation of care.
• Provides Important Medicare Letter of Rights to resident and / or patient and / or family and obtains signature on form as warranted within 24 hours prior to discharge if applicable.
• Provides Notice of Medicare Non-Coverage to resident and / or responsible party and obtains signature 48 hours prior to discharge if applicable
• Follows Medicare appeal process and keeps log as needed.
• Completes and posts discharge notification forms prior to discharge to interdisciplinary team.
• Documents resident and / or patient progress notes on a weekly basis or as needed in the Medical Record.
• Serves as a liaison with physician and continuously communicates regarding resident and / or patients status and / or concerns.
• Participates in daily management team meetings to discuss patient and / or residents status census changes and patient and / or residents complaints or concerns.
• Conduct follow up phone calls 48 hours after discharge.
• Obtain HMO level increases such as IVs (high cost drugs) special equipment and change in skilled needs if applicable.
• Communicate and coordinate with third party bundle payment programs if applicable
• Conduct 30 day follow up phone calls to monitor returns to acute.
• Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of the position.

Other Duties

from patient and / or residents or families and informs to the Director Case Management / Social Services.

Supervisory Responsibility

Physical Requirements

Disclaimer

The job description is not designed to cover or contain a comprehensive listing of activities duties or responsibilities that are required of the employee. Other duties responsibilities and activities may change or be assigned at any time.

EEOC Statement

CHS provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race color religion age sex national origin disability status genetics protected veteran status sexual orientation gender identity or expression or any other characteristic protected by federal state or local laws.

This policy applies to all terms and conditions of employment including recruiting hiring placement promotion termination layoff recall transfer leaves of absence compensation and training.

PM19

Requirements

Knowledge & Experience Requirements

Required Experience :

Manager

Key Skills

Project Portfolio Management,Motivational Interviewing,HIPAA,Computer Skills,Intake Experience,Lean Six Sigma,Conflict Management,Case Management,Team Management,Program Development,Social Work,Addiction Counseling

Employment Type : Full Time

Experience : years

Vacancy : 1