Case Manager - LMSW / RN

Choose to be an integral part of a team that helps patients achieve their greatest potential and work toward productive, independent lives. The Case Manager exists to coordinate health care decisions by using a systematic approach to assure treatment plans that improve quality outcomes, coordination of care across the continuum; promotion of cost-effective care within the allotted time frame; assuring payments of hospital-based services meet patient-related utilization management criteria, and implementation of safe and appropriate discharge plans.  The Case Manager assesses the needs of the patient and provides intervention as part of the discharge planning process. The primary job function in Case Management includes: Clinical interventions/Discharge and Care Planning Management; Fiscal Management; and Payer/Referral Management.

Employees in this position will:

1. Responsible for functioning as the liaison among all parties involved with the patient both within the hospital and in the community as it relates to the development and implementation of a safe and appropriate discharge plan, as well as the supervision of clinical interventions that may become critical to the development and implementation of the discharge plan. Provides Case Management assessment and intervention as part of the discharge care planning proc The Case Manager participates as part of the interdisciplinary team developing, implementing, reviewing and revising the interdisciplinary plan of care.

2. Assures responsiveness to payer systems by maintaining ongoing communication and serving as the primary contact for all external payer sources, in turn generating revenue, enhancing reimbursement, minimizing financial risk and assuring payment for the hospital. Maintains a thorough understanding of insurance coverage and benefits, providing interpretation to patients/families of their insurance and providing patient advocacy as needed.

3. Identifies and fulfills the requirements and needs of payer and referral sources, overseeing negotiations of continue stay rationale, length of stays, and appeals proces Initiates activities to develop positive business relationships with payers and referral sources in order to promote repeat business and represent the hospital as a quality institution.

4. Responsible for attending education/in-servicing on current trends in case management, policies and procedures of the organization, and changes in governmental, regulatory, and accrediting agencies to ensure compliance with standards of practi

5. Carries a patient caseload.

6. Assures personal compliance with departmental documentation and timeliness of the same, e.: initial assessments, advanced directive, team conference reports. Conducts chart audits on a regular basis to maintain compliance, as requested by manager.

7. Develops and maintains updated departmental community resource materials and patient education materials. Responsible for keeping abreast of current information regarding entitlement programs patients may need to utiliz

8. Identification of inter-department and intra-department performance improvement projects, and carrying out of the sam

9. Coordinates with other departments to assure positive fiscal management outcomes for the patien

10. Responsible for developing and maintaining effective interdisciplinary working relationships with other clinical treatment team members in order to assure clinical outcomes that are appropriate, cost-effective, and beneficial to the patien

11. Perform other duties as requested.