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Catastrophic Case Manager

Department: Case Management
Reports to: Manager of Case Management

Summary
The Case Manager has the responsibility to identify, assess, plan, coordinate, implement, monitor, and evaluate options and services for individuals requiring case management services. The goal of the case manager is to provide for quality, cost-effective outcomes for the client through collaboration and communication with the client, the family, the physician, and other members of the health care team.

Responsibilities and Duties
Processes the case utilizing client's outcome management model and tools

Obtains written authorization for case management services as well as release of information

Assesses the client/family to identify their strengths and resources; problems; psychosocial, financial, and medical history; current status; diagnosis; prognosis; functional status; goals; current treatment plan; and needs

Develops a plan of care with client’s model through interdisciplinary collab-oration, which identifies realistic short- and long-term goals

Identifies, secures, and coordinates the services and resources to implement the plan

Monitors services being provided for continued appropriateness and reports to client and carrier

Evaluates the client’s progress, the plan, and the appropriateness of the services provided, with modifications as necessary

Provides ongoing instruction to the client and family regarding the injury/dis-ease process, treatment options, and present care

Promotes the client’s/family’s self-advocacy skills to achieve maximum self-sufficiency

Has knowledge of the benefit package as well as all available funding sources and systems of care and coordinates with the payer for authorization of payment

Provides for in-depth reporting of outcomes encompassing clinical, functional,
financial, and customer satisfaction areas

Demonstrates effective, accurate, and timely verbal and written communication
in all work situations

Identifies and discloses all situations which might result in exposure to legal liability
and/or are indicative of poor-quality care negatively affecting the client

Frequently requires travel to patient appointments.

Performs other related duties as assigned in accordance with the necessary job
function

Supervisory Responsibilities
This position has no supervisory responsibilities.

People Contact
This position requires regular contact both within the company and outside the company
in order to carry out company policies and procedures. Requires abilities of persuasion
and cooperation. Often deals with persons of equal or higher rank.

Decision Making
This position requires frequent decision making and the ability to plan and perform unusual
or difficult work with general operation methods/procedures.

Supervision Received
This position exercises considerable latitude in determining objectives and approach to
assignments. Completed work is reviewed from a long-term perspective for desired results.

Minimum Position 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 and/or Experience:
Registered nurse
BSN preferred
CCM or equivalent certification
Three years or more of related experience and/or training or equivalent combination
of education and experience

Language Skills:
Ability to read, analyze, and interpret medical information, professional journals,
technical procedures, governmental regulations, and standards of care
Ability to effectively present information and respond to questions from customers,
managers, and clients as appropriate

Mathematical Skills:
Ability to add, subtract, multiply, and divide in all units of measure, using whole
numbers, common fractions, and decimals
Ability to compute rate, ratio, and percent and to draw and interpret bar graphs
Reasoning Ability:
Ability to solve practical problems and deal with a variety of concrete variables
in situations where only limited standardization exists
Ability to interpret a variety of instructions furnished in written, oral, diagram,
or schedule form

Computer Skills:
Knowledge of database software, internet software, and Microsoft word processing
software

Certificates, Licenses, Registrations:
RN license in state(s) where cases are to be managed
Valid driver’s license
Valid automobile liability insurance

Other Skills and Abilities:
Ability to organize and evaluate workload and prioritize projects
Ability to meet deadlines
Ability to complete multiple, simultaneous projects with accuracy and efficiency
Detail orientation
Contract-level acceptance by Paradigm of the Case Manager to manage their
cases

Physical Demands
The physical demands described are representative of those that must be met by an employee
to successfully perform the essential functions of this job. Reasonable accommodation
may be made to enable individuals with disabilities to perform the essential
functions.
While performing the duties of this job, the employee regularly is required to sit and
talk or hear. The employee frequently is required to stand and walk. The employee frequently
is required to use hands to finger, handle, or feel and to reach with hands and
arms. The employee occasionally is required to stoop, kneel, or crouch. The employee
occasionally must lift and/or move up to ten pounds. Specific vision abilities required
by this job include close vision (clear vision at 20 inches or less), distance vision, peripheral
vision, and ability to adjust focus.

Work Environment
The work environment characteristics described here are representative of those an
employee encounters while performing the essential functions of this job. Reasonable
accommodation may be made to enable individuals with disabilities to perform the essential
functions.
The noise level in the work environment is usually moderate.

At Will Employment

Employment at SCM Associates, Inc. is based on mutual consent, and both the employee
and SCM have the right to terminate employment at will, with or without cause, with or
without advance notice.