Case Manager - PRN | Clarksville Rehab
Case Manager (RN, OT, PT, SLP or LSW)The Case Manager is responsible for the interdisciplinary coordination of care for a designated patient population.
The Case Manager performs reviews of all inpatient admission records to ensure proper utilization of hospital resources and determination of admission for appropriate level team to facilitate achievement of desired financial and quality outcomes.
The Case Manager will also maintain and enhance payor relationships.
Performs other related duties as assigned or requested.
This is an exempt position.
RESPONSIBILITIESAdmission Data Collection and AssessmentoAssesses, plans, monitors, and coordinates plan of care from pre-admission to community re-entry through the implementation of case management standards and processes.
oAssesses the individual's personal and medical history, current status, diagnosis, prognosis, and the proposed treatment plan.
oPromotes and utilizes the appropriate level of care for the patient and refers to other facilities as needed.
oAdheres to contract agreements and specific criteria.
oServes as a liaison with payor source points of contact to verify and guarantee coverage and identify items required to process the claim for service.
oAssists patient and or caregiver in developing realistic goals to direct the treatment regimen.
oProactively communicates with payor source to explore coverage solutions (flex benefits, out of contract, etc.
).
Planning, Implementation & FacilitationoPromotes optimal outcomes for the patient within the boundaries of the diagnosis.
oCoordinates and facilitates interdisciplinary team (IDT) meetings and plan of treatment.
oMeets with patient, family, and IDT to facilitate continuity of care.
oImplements utilization review process and continuously evaluates the appropriate level of care with the interdisciplinary team and payor, and patient/caregiver(s).
Proactively obtains authorization for any extension of service of LOS.
oCoordinates the discharge plan with the IDT and providers.
oMonitors expense versus revenue for caseload on a daily basis.
AdvocacyoProactively collaborates with the health care team, payors, community agencies, providers and legal representatives to ensure continuity throughout the continuum.
oServes as a liaison with the treatment team and the primary care physician, referring physician, medical director, patient/caregiver(s), and other parties as appropriate.
oPromotes effective communications among treatment team members, patient/caregiver(s), primary care physician, referring physician, medical director, and payor.
oParticipates in care conferences, family conferences, etc.
when indicated.
oEducates and supports the individual/family to be empowered and self-reliant in being advocates for themselves.
oUses the mechanism of early referral to promote and provide optimum care and cost containment.
oRepresents the individual's best interests through assisting in finding necessary funding, offering treatment alternatives, and coordinating treatment.
Monitoring & EvaluationoContinuously reviews and evaluates the patient's progress, as reflected by the goals defined in the treatment plan.
oUses appropriate auditing processes and tools to ensure department and treatment efficiency.
oParticipates in performance improvement evaluation processes with particular emphasis on results-oriented treatment.
Professional GrowthoMaintains professional growth in case management by:
attending continuing education opportunities; reviewing pertinent professional literature; maintaining knowledge of current community resources; and reviewing and being familiar with the managed care marketplace to determine managed care growth potential, opportunities, penetration, service trends, relationships, networks, etc.
QUALIFICATIONSEducation and Training:
RN, OT, PT, SLP or LSW licensure in state where the hospital resides required.
Current BLS certification required.
Experience:
Three to five years of inpatient experience, preferably in an acute, IRF or LTACH setting.
Recommended Skills Auditing Basic Life Support Case Management Communication Data Collection Finance Estimated Salary: $20 to $28 per hour based on qualifications.
The Case Manager performs reviews of all inpatient admission records to ensure proper utilization of hospital resources and determination of admission for appropriate level team to facilitate achievement of desired financial and quality outcomes.
The Case Manager will also maintain and enhance payor relationships.
Performs other related duties as assigned or requested.
This is an exempt position.
RESPONSIBILITIESAdmission Data Collection and AssessmentoAssesses, plans, monitors, and coordinates plan of care from pre-admission to community re-entry through the implementation of case management standards and processes.
oAssesses the individual's personal and medical history, current status, diagnosis, prognosis, and the proposed treatment plan.
oPromotes and utilizes the appropriate level of care for the patient and refers to other facilities as needed.
oAdheres to contract agreements and specific criteria.
oServes as a liaison with payor source points of contact to verify and guarantee coverage and identify items required to process the claim for service.
oAssists patient and or caregiver in developing realistic goals to direct the treatment regimen.
oProactively communicates with payor source to explore coverage solutions (flex benefits, out of contract, etc.
).
Planning, Implementation & FacilitationoPromotes optimal outcomes for the patient within the boundaries of the diagnosis.
oCoordinates and facilitates interdisciplinary team (IDT) meetings and plan of treatment.
oMeets with patient, family, and IDT to facilitate continuity of care.
oImplements utilization review process and continuously evaluates the appropriate level of care with the interdisciplinary team and payor, and patient/caregiver(s).
Proactively obtains authorization for any extension of service of LOS.
oCoordinates the discharge plan with the IDT and providers.
oMonitors expense versus revenue for caseload on a daily basis.
AdvocacyoProactively collaborates with the health care team, payors, community agencies, providers and legal representatives to ensure continuity throughout the continuum.
oServes as a liaison with the treatment team and the primary care physician, referring physician, medical director, patient/caregiver(s), and other parties as appropriate.
oPromotes effective communications among treatment team members, patient/caregiver(s), primary care physician, referring physician, medical director, and payor.
oParticipates in care conferences, family conferences, etc.
when indicated.
oEducates and supports the individual/family to be empowered and self-reliant in being advocates for themselves.
oUses the mechanism of early referral to promote and provide optimum care and cost containment.
oRepresents the individual's best interests through assisting in finding necessary funding, offering treatment alternatives, and coordinating treatment.
Monitoring & EvaluationoContinuously reviews and evaluates the patient's progress, as reflected by the goals defined in the treatment plan.
oUses appropriate auditing processes and tools to ensure department and treatment efficiency.
oParticipates in performance improvement evaluation processes with particular emphasis on results-oriented treatment.
Professional GrowthoMaintains professional growth in case management by:
attending continuing education opportunities; reviewing pertinent professional literature; maintaining knowledge of current community resources; and reviewing and being familiar with the managed care marketplace to determine managed care growth potential, opportunities, penetration, service trends, relationships, networks, etc.
QUALIFICATIONSEducation and Training:
RN, OT, PT, SLP or LSW licensure in state where the hospital resides required.
Current BLS certification required.
Experience:
Three to five years of inpatient experience, preferably in an acute, IRF or LTACH setting.
Recommended Skills Auditing Basic Life Support Case Management Communication Data Collection Finance Estimated Salary: $20 to $28 per hour based on qualifications.
|
|
 | |
