GENERAL SUMMARY OF DUTIES:
The Case Manager works with physicians and other members of the multidisciplinary team to develop a plan for each patient from admission to discharge utilizing the unit.
REQUIREMENTS:
- Bachelor’s degree required.
- Licensure as a vocational or registered RN required.
- CCM preferred.
- Minimum of 5-10 years previous case management experience preferred.
- Basic knowledge of CMS guidelines and experience working with payor specific guidelines and contractual rules preferred.
- Skills necessary to provide excellent customer service, including effective listening.
- Critical thinking skills, decisive judgment and the ability to work with minimal supervision meeting firm deadlines.
- Communication skills are necessary to be a good listener and speak in an understandable way.
- Ability to be assertive with persuasive communication skills; action oriented.
- Ability to be organized and efficient with time.
- Ability to be compassionate to people and their situations to work with them in a positive way that will help them make good forward strides.
ESSENTIAL FUNCTIONS:
- Performs continuous assessments and evaluations to ensure the patient is progressing towards desired outcomes.
- Assesses and responds to patient/family needs by coordinating efforts of other team members.
- Identifies and resolves barriers that hinder effective patient care.
- Collaborates and consults with physicians on patient's progress and discharge planning needs.
- Performs utilization review ensuring admissions meet criteria for appropriateness of care and medical necessity.
- Manages the process to review and, as appropriate, appeal denials received from payors.
- Coordinates the discharge planning process ensuring involvement of all members of the healthcare team.
- Counsels with patients and family members in decision making and in meeting psychosocial needs of the patient.
- Collaborates with personnel at other facilities to coordinate smooth and effective patient transfers and transitions.
- Compiles, evaluates, and reports statistics to members of the team and utilizes the information to facilitate process improvement activities.
- Supports and participates in hospital safety programs, infection control and other processes to ensure a safe environment.
PHYSICAL DEMANDS:
- The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- While performing the duties of this job the employee is frequently required to sit, converse, and listen; use hands to touch, handle, or feel objects, tools or controls; and to reach with hands and arms. Specific vision abilities required by this job include close vision and the ability to adjust focus.
- The employee must be able to lift and/or carry over 15 pounds on a regular basis and be able to push/pull over 15 pounds on a regular basis.
- The employee must be able to stand and/or walk at least five hours per day.
WORK ENVIRONMENT:
- The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
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