Case Manager

Staff Position Description

Position Title:

Case Manager

Position Code:
Case Mgr-____

Department:
Case Management / Behavioral Health

Safety Sensitive: YES

Reports to:

Manager/Director

Exempt Status: YES

All KHI employees are expected to perform their respective tasks and duties in such a way that supports KHI’s vision to be among the kindest, highest quality health systems in the country.

This position provides support to the patients and their families served  scope of responsibilities includes coordinating, providing, and maintaining activities to meet the needs of the patients and their families from adult to geriatric.

Collaborates with Physicians, Nurses, Social Workers, and other hospital departments as necessary, to facilitate the improvement in the quality of care and/or the efficiency with which hospital services are utilized. Ensures the active involvement of the patient and or family in the evaluation process and provides assistance with planning and arranging post hospital services. Identifies appropriate community resources for each assigned patient and works collaboratively with patients, families, multidisciplinary team members and community agencies to achieve desired patient outcomes.

Ensures initial implementation of the discharge plan and appropriate education regarding discharge plan to patient and family to facilitate a safe transition of care from the hospital to home or another facility. Performs Utilization Review (UR) to determine medical necessity for admission, continued stay, appropriate utilization of resources and level of care determination based upon MCG criteria. Communicates medical necessity information with the requesting Payers, as per KHI policies and procedures.

In conjunction with the Discharge Care Coordinator, determines whether required post discharge services are covered by the patient’s payer and informs patient of coverage determinations. Maintains accurate and timely documentation of patient assessments, continuing reassessments, and discharge plans.

• Conducts assessment and evaluation of admitted patients for medical, physical, and psychological factors that may contribute to their disease process and may require specific or complex continuing care and/or supportive services.
• Reviews medical records concurrently and retrospectively as necessary to assess the management of cases by comparing progress to predetermined criteria.
• Evaluates for medical necessity, level of care, coverage issues, appropriate utilization of resources, and planning by reviewing physician documentation to ensure that MCG criteria is met.
• Collaborates with members of the healthcare team concerning patient’s assessment, goals, care plan and progress.
• Performs ongoing assessments of patients for continuing care needs such as, Skilled Nursing Facilities (SNF’s), acute Long Term Care Facilities, Durable Medical Equipment (DME), and Home Health.

• Participates in Multidisciplinary Rounds (MDR) to assist with the development of care plans that will meet the patient’s current and continuing healthcare needs.
• Serves as an advocate for the patient and protects patient right’s as they pertain to the ethical and legal issues of confidentiality during the case management process.
• Based on patient assessment, develops a discharge plan, per KHI’s Discharge Planning policy, to coordinate the provision of goods and services with referrals to specific providers, and ensures initial implementation of the discharge plan in collaboration with the Discharge Care Coordinator.
• Based on patient’s assessment and collaboration with the healthcare team, and the patient/family, the Case Manager develops and documents the discharge plan by identifying the needs of the patient and the availability of resources to ensure a safe transition from the hospital. The Case Manager assists patients and their families with needs, such as complex discharge planning needs, suspected emotional, cognitive, or mental problems, financial issues, and home/environmental issues.
  
  When identified,…