The Case Manager is responsible for enhancing the quality of patient management and satisfaction, to promote continuity of care and cost effectiveness through the integrating and functions of case management, utilization review and discharge planning. The incumbent in this role adheres to strict departmental goals/objectives, standards of performance, regulatory compliance, quality patient care compliance and policies and procedures.
ESSENTIAL JOB DUTIES/RESPONSIBILITIES:
- Coordinates the integration of social services/case management functions into the patient care, discharge and home planning processes with other departments, external service organizations, agencies and healthcare facilities.
- Conducts concurrent medical record review using specific indicators and criteria as approved by medical staff.
- Acts as a patient advocate: investigates and reports adverse occurrences and performs staff education related to resource utilization, discharge planning and psychosocial aspects of healthcare delivery.
- Promotes effective and efficient utilization of clinical resources and mobilizes resources to assist in achieving desired clinical outcomes within specific timeframe.
- Conducts review for appropriate utilization of services from admission through discharge. Evaluates patient satisfaction and quality of care provided.
- Communicates with physicians at regular intervals throughout hospitalization and develops an effective working relationship. Assists physicians in maintaining appropriate cost, case and desired patient outcomes.
Other responsibilities may include:
- Coordinates the provision of social services to patients, families and significant others to enable them to deal with the impact of illness on individual family functioning and to achieve maximum benefits from healthcare services.
- Completes expanded assessment of patients and family needs at time of admission. Completes psychosocial assessment.
- Refers cases where patients and/or family would benefit from counseling to complete complex discharge plan to social worker.
- Serves as a patient advocate. Enhances a collaborative relationship to maximize the patient’s and family’s ability to make informed decisions.
- Facilitates interdisciplinary patient care rounds and/or conferences to review treatment goals, optimize resource utilization, provide family education and identified post-hospital needs.
- Directs and participates in the development and implementation of patient care policies and protocols to provide advice and guidance in handling special cases or patient needs.
- Performs other duties as assigned and modified at manager’s discretion.
KNOWLEDGE, SKILLS AND ABILITIES:
- Thorough knowledge of case management principles, healthcare management and reimbursement.
- Strong written and verbal communication skills; presentation skills.
- Ability to convey medical terms and treatment plans so they are understood by patients and their caregivers.
- Excellent organizational and time management skills.
- Astute problem-solving skills with the ability to multi-task.
- Compassionate and empathetic demeanor with the ability to work both independently and in a group/team environment.
- General computer knowledge and effective Microsoft Office Products (PowerPoint, Excel, Word and Outlook) skills, plus the ability to use a variety of other word-processing, spreadsheet, database, e-mail and presentation software.
- Ability and willingness to travel locally, regionally and/or nationwide up to 10% of the time.
- Spoken and written fluency in English.
EDUCATION AND EXPERIENCE CRITERIA:
- High school diploma or equivalent required.
- Bachelor’s degree in a healthcare related field preferred.
- Valid, active licensure as professional nurse (RN, LPN or other nursing discipline) required.
- A minimum of 7 years’ utilization review/case management experience, including psychological aspects of care.
- A minimum of 7 years’ experience in discharge planning from a hospital is preferred.
- Experience in case management in a hospital and/or healthcare setting highly desired.