Case Manager II

About This Role

This role coordinates and facilitates patient care by collaborating with the Interdisciplinary Care Transitions team. The goal is to ensure optimal resource utilization, service delivery, and compliance while enhancing patient satisfaction.

Responsibilities

• Coordinate clinical and/or psycho-social activities with the Interdisciplinary Team and Physicians
• Monitor patients' stay for effective care coordination and efficient care facilitation
• Stay current on reimbursement modalities, community resources, case management, psychosocial and legal issues
• Refer high-risk patients for additional support
• Serve as a patient advocate to maximize informed decisions
• Participate in interdisciplinary patient care rounds to review treatment goals and identify post-hospital needs
• Collaborate with clinical staff in developing and executing care plans
• Coordinate with care team, physicians, patients, families, and payors for care planning throughout the continuum
• Conduct comprehensive, ongoing assessment of patients for timely and safe discharge planning
• Provide comprehensive discharge planning and communicate effectively with patient/family
• Conduct medical necessity review for appropriate utilization of services from admission through discharge
• Promote effective and efficient utilization of clinical resources
• Conduct timely and accurate clinical reviews and coordinate continued stay authorization with payor

Requirements

• Knowledge of government and non-government payor practices, regulations, standards and reimbursement
• Knowledge of Medicare benefits and insurance processes and contracts
• Knowledge of accreditation standards and compliance requirements
• Ability to demonstrate critical thinking, appropriate prioritization and time management skills
• Basic computer skills with working knowledge of Microsoft Office, word-processing and spreadsheet software
• Excellent interpersonal, verbal and written communication skills
• Good interpersonal skills when working or interacting with patients, their families and other staff members
• Must read, write and speak fluent English

Qualifications

• Graduate of an accredited program required for RN or BSN preferred or MSW/BSW with licensure
• Two years of experience in a healthcare setting preferred, prior experience in case management, utilization review, or discharge planning preferred

Skills

* Required skills

Benefits

Certifications