Care Manager​/Case Manager

Responsibilities

• Develops an integrated link between patients, families, local resources, insurance representatives and hospital; enhances communication among these parties to assure appropriate and timely utilization and access to services and exchange of information, therapeutic interventions and advocates for the rights and needs of patients.

• Ascertains patient’s medical, psychological, emotional and social needs by interviewing patients, completing initial care management assessments, screening for potential discharge planning needs, and communicating with the treatment team.
• Develops therapeutic intervention plans according to needs by exploring options, setting goals, and establishing rapport with patients and significant others.
• Obtains services and resources for patients by determining appropriateness, referring to community resources, and establishing rapport with agencies and support groups.
• Represents the rights and needs of patients by educating and informing them about their rights and advocating on their behalf with community resources, insurers, and the treatment team.
• Coordinates treatment and discharge plans by leading interdisciplinary team meetings and bridging communication between team members, ancillary departments, insurers, and significant others.
• Maintains documentation with appropriate and timely notations in the medical record, departmental files, hand‑off communication documents (e.g., POD reports), electronic documentation systems, and databases.
• Addresses patient safety by identifying and communicating safety issues to the team, patient/family, relaying recommendations for a safe discharge plan to patient/family, assisting in resolving care issues by making referrals, and reporting to regulatory agencies as required.
• Coordinates utilization management processes by reviewing clinical information based on admission and continued stay criteria, performing concurrent medical reviews to communicate with payers, initiating physician advisor reviews for cases not meeting established criteria, communicating denials from third‑party payers to physicians, coordinating a timely appeals process, and obtaining signatures on admission paperwork/advance directive forms where applicable.
• Demonstrates a professional demeanor and maintains professional knowledge by being flexible, responding positively to unexpected changes in workload and hours, performing other duties as directed, and keeping abreast of regulations and policies related to utilization management and discharge planning, departmental staff meeting information.

• Education:
  
  Bachelor’s Degree required, Master’s Degree preferred.
• Work Experience:
  
  1–2 years of related experience required.
• Licenses /
  
  Certifications:
  
  None specified.
• Other:
  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.