Case Manager Job Summary
Provides case management services aimed at enhancing client-centered care and maximizing outcomes. Case management services include:
- acting as an advocate on the part of the client
- monitoring client care to ensure progress toward desired outcome
- addressing client and family needs
- resolving obstacles to effective care
- obtaining authorization for services from third party payers
- developing a relationship with clients as the first step of successful case management
- coordinating and relaying information to medical providers, employers and attorneys, when applicable
This position requires a degree in Nursing or equivalency; current RN licensure in the state of practice; two years of professional experience in a clinically related area; and demonstrated team leadership, relationship building, critical analysis, and written and verbal communication skills. Knowledge of funding resources and clinical standards and outcomes is also required. Licensure and certification confirmed with the issuing body prior to beginning employment and annually thereafter, by the assigned supervisor.
A Certified Case Management designation is preferred. Previous experience in resource management activities, worker’s compensation, geriatric care, disease management and third party payer interactions is preferred.
Care is appropriate to the population served.
Applicants must demonstrate the potential ability to perform the essential functions of the job as outlined in the position description.
This job description has been designed to indicate the general nature and level of work performed by employees within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities and qualifications required of employees assigned to the job.
- Acts as a liaison to coordinate care/resources and identifies issues or concerns with the client, physicians, medical providers, social workers, rehabilitation providers, and other team members to promptly problem solve and achieve optimal client outcomes.
- Monitors, analyzes and documents quality of care to ensure individualized client care plan goals are appropriate and, understood and implemented in a cost effective manner via medical records review, on site face to face visits with client/employer/medical providers, telephonic follow up and attendance of medical appointments. Routinely assesses client (and family when applicable) response to services, while also measuring care plan effectiveness and necessity. Also identifies client needs, including those of an ethical and cultural nature, and ensures they are addressed.
- Maintains objectivity at all times.
- Facilitates cost effective outcomes by determining appropriate level of care based on diagnosis, severity, intensity of services required, and other relevant criteria, using national and regional standards and community norms.
- Assesses, discusses (and relays to the account/customer) funding and insurance coverage issues with client, family, and healthcare providers to enhance cost effective utilization of services and quality outcomes.
- Discusses, and when appropriate or applicable negotiates, with third party payers relative to benefit levels, eligibility, utilization review, and reimbursement.
- Secures and maintains appropriate release of information for each client.
- Respects confidentiality at all times.
- Identifies actual and potential delays in service requests or treatment and communicates them to the team so steps can be taken to eliminate or minimize delays.
- Works with other team members to plan appropriate and timely discharges, when applicable.
- Establishes measurable case management goals that promote cost effective, high quality outcomes.
- Supervises administrative support staff assigned to individual case management team(s).
- Represents the company in a manner that exemplifies the values/mission statement of Arch Care Consultants
- Other duties, as assigned
*Annual Evaluations by the supervisor and/or clinical manager will be completed to assess the case manager’s ability to provide essential functions of the job.
The Case Manager has the authority to negotiate with third-party payers on benefit levels, eligibility, utilization review, and reimbursement, and must do so in accordance with guidelines from third party payers and other funding sources. Responsibilities must be carried out in accordance with the case manager's professional code of ethics, and, state and federal regulations. The Case Manager must use independent judgment to assess and meet client needs. A major challenge is interaction with clients, families, various patient care disciplines, ancillary departments, health care and community agencies, and third party payers in coordinating care and services for clients.
- Extensive travel, occasional overnight travel may be required
- Valid, unrestricted driver’s license with adequate and, when applicable, minimum state required auto insurance
- Reliable transportation
- Working phone service and fax line, accessible from home office at a minimum, or via cell service and electronic fax
- Working cell phone service for access during normal business hours of Monday through Friday, 8:00 am to 5:00 pm
- Personal computer with internet access to send/retrieve email communication
- Excellent verbal/written communication skills
- Time management skills
- Highly organized and flexible in scheduling reports, completing paperwork and report activity
- Repetitive use of hands for fine motor manipulation, ie computer keyboard, handwritten reports
- Occasional bending, kneeling, stooping and climbing
- Occasional lifting up to twenty pounds floor to waist level
Arch Care Consultants
Why Work Here?We are a female owned and run business that operates in over 35 states from Maine to California. We are growing but still retain our small business charm even after over a decade in operation.
Home office based position with a fast growing company that still retains a small business feel. Amazing, empathetic, and inspiring CEO.