Care Manager

Job description

• JOB SUMMARY
• The case manager is responsible for the development of a comprehensive and goal oriented plan of care as it relates to providing ongoing psychosocial assessment, screening for potential needs, discharge planning, and communication with the clinical team and professional staff; Acting as a liaison between the patient, the clinical team, and utilization manager; the management of individual caseloads of patients through interaction with families, conducting weekly interdisciplinary team meetings and assisting patients and families with discharge planning; supporting the case management department needs by functioning as a utilization manager as needed.
• ESSENTIAL FUNCTIONS
• PATIENT / CUSTOMER
• Essential Accountabilities
• Ensures communication and collaboration with supervisors and fellow co-workers to serve patients and other customers to the best of his/her ability.
• Is professional in all actions and appearance
• Anticipates patients’/customers’ needs and acts accordingly.
• Works to enhance patient satisfaction
• Analyzes problems from the customers’ point of view.
• Honors patient/customer/employee confidentiality.
• Seeks feedback on how to improve performance and offers constructive feedback, as well.
• Assist patients and families
• Applies learning for improved performance.
• Demonstrates understanding and ownership of how his/her role contributes to achieving the success of the Department and GSPP.
• Demonstrates a personal commitment to ensuring a clean and safe working environment.
• Uses resources wisely – as if they were one’s own.
• Non-Essential Accountabilities
• Strives to understand and value differences in others’ race, nationality, gender, age, background, experience, and style.
• Assists in orienting new employees/staff, if/as needed.
• Attends staff meetings and continuing education in-service training as directed by supervisor.
• PATIENT/ EMPLOYEE SAFETY ACCOUNTABILITIES
• Non-Patient Care
• Participates in GSPP and Department wide initiatives for Patient /Employee safety
• Demonstrates an awareness of patient/ employee safety when carrying out daily responsibilities of their position.
• Patient Care Providers
• Participates in GSPP and Department wide initiatives for Patient /Employee safety
• Demonstrates an awareness of patient/ employee safety when carrying out daily responsibilities of their position.
• Validation of annual competencies required for the position
• OPERATIONS
• Responsible for planning, organizing and evaluating interventions and their effect on the discharge outcome.
• Lead weekly team conferences to coordinate patient care and discharge planning with the interdisciplinary team. Document as appropriate in EMR platform.
• Initial and ongoing psychosocial assessment to identify potential discharge needs and develop a discharge plan. Ascertains patient’s medical, psychological, emotional, and social needs are obtained and addressed by the interdisciplinary team.
• Documentation of admission in appropriate EMR platforms.
• Prepare the patient and the family for discharge. Ensures family education is completed prior to discharge.
• Establish family conferences as needed/required.
• Provide patients/families with information regarding choice of next level of care.
• Arrange for post-discharge services: home health care services, durable medical equipment delivery, access to medications, skilled nursing placement, referrals to community resources. etc.
• Work with case management team to improve the awareness of resources available to support the transition of patients into their community.
• Arrangements for transportation at the time of discharge, and continued in the community setting.
• Inform patients of their rights under CMS/Medicare guidelines.
• Promote utilization of available resources to achieve cost effective outcomes.
• Maintains current knowledge of regulations affecting utilization management and utilization review.
• Facilitates educational programs and advises physicians, and other departments, or regulations affecting discharge planning process Provides utilization management coverage for utilization manager during times of SPTO/USPTO as necessary.
• 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 in Nursing or Social Work required
• Master's Degree preferred
• Work Experience
• 3-5 years of relevant case management experience required
• Previous experience in utilization review preferred
• Licenses / Certifications
• Registered Nurse license required OR
• LSW / LCSW, and/or Certified Case Manager (CCM) preferred