POSITION SUMMARY
Using discretion and independent judgment, the Case Manager isresponsible for all case management activities assigned. This includes case management and utilizationmanagement. The Case Manager providesconcise management of patients' hospitalization from pre-admission throughdischarge in the areas of patient care, fiscal management, and Payor/referralsatisfaction. The Case Manager is responsible for conducting Discharge PlanningEvaluations, performing discharge planning to ensure patients and theirfamilies receive maximum benefits, and awareness of community and governmentagencies. This position requires the use of communication skills, the abilityto perform management operations directly related to administrative goals andpolicies, to provide regular and direct assistance to executives, to performwork and special assignments under only very general supervision, and tocontinuously develop department operations toward efficiency and effectiveness.
POSITION QUALIFICATIONS
Thisposition requires a MSW or LCSW with at least three (3) years of workexperience in a medical case management setting. Exceptions are made with CEO approval. Good organizational and liaison capabilitieswith well-developed written and verbal communication abilities arerequired. Well demonstrated public relationsskills with a cooperative and assertive attitude. Working knowledge of the insurance industryis required.
RESPONSIBILITIES
1.Have an understanding of the commercial insurance appeal process.
2.Have a working knowledge of billing ad reimbursement and letter of agreement.
3.Be knowledgeable regarding pre-certification and concurrent review process.
4.Must have clear and concise professional language in the preparation of up to date clinical reports representing the patient's total condition and treatment plan.
5.The Lead Case manager, Director of Case Management or a department representative will participate in a brief portion of the hospital liaison/ marketing meeting to share positive and challenging case-specific, case type, or data-based outcomes. Routine participation allows for a positive exchange of information between the departments to identify high risk factors that could potentially affect the outcome of future admissions.
6.Have working knowledge of Federal and State Regulatory Compliance.
7.Be responsible to document case-based activities with treatment plan/ discharge plan interventions.
8.As the designated team leader have a good working knowledge and ability to facilitate interdisciplinary team conference identifying clinical challenges and outstanding issues.
9.Ability to discharge patients successfully without adverse health consequences with all needs identified.