Case Manager

JOB TITLE: Case Manager

REPORTS TO: Administrator

FLSA STATUS: Non-Exempt

JOB OVERVIEW: In collaboration with the physician provides individual program

management for each patient to ensure the patient's progression through the continuum of care in

a manner that achieves the desired clinical and financial outcomes. Monitors and manages

clinical and financial coordination of treatment plan of assigned patients to ensure timely, cost-effective, individualized service delivery. Works with rehabilitation patients with various

disabilities including, but not limited to: spinal cord injury, brain injury, cerebrovascular

accident, amputation, neurologic disorders, orthopedic conditions, and arthritis. Coordinates

length of stay management within Medicare (CMS) guidelines and 60% compliance threshold.

ESSENTIAL FUNCTIONS INCLUDE BUT ARE NOT LIMITED TO:

a. Meets with patient upon admission to discuss rehabilitation process and role of

case manager.

b. Conducts and documents initial patient assessment within 72 hours, to include

psychosocial, family and disposition status; determines tentative initial discharge

plans in conjunction with patient and family goals.

c. Appropriately modifies approach to the patient based upon patient's age and

developmental level.

d. Involves the patient/family in the development of the plan of care by obtaining

their goals for rehabilitation.

e. Reviews goals with patient's family (with patient's permission) and third party

payer.

f. Maintains accurate up-to-date documentation in the medical records of patient and

family contacts, communications with payers and other services performed on

behalf of patient and family.

g. Coordinates, evaluates, documents and reviews interdisciplinary team goals as

they pertain to the plan of care and discharge plan.

h. Coordinates team conferences.

i. Documents in the medical record a summary of the team conference.

j. Serves as the primary family contact (with patient permission) for the treatment

team, communicating within 48 hours of the team conference. Also updates the

external case manager and/or payer source regarding progress, plan and patient's

future needs (as requested by payer source).

k. Ensures the scheduling of family conferences, family participation in therapy and

provides pertinent information to appropriate team members.

l. Documents in the medical record a summary of the family conference.

m. Coordinates completion of discharge plans by assisting with arrangements for

family education, equipment and services as appropriate for patient discharge

level of care.

n. Calls patient or family as needed post-discharge to ensure planned discharge

recommendations are occurring and to assess if additional services are needed.

o. In collaboration with the Controller, monitors and ensures needs of per diem

negotiations, recertification, concurrent reviews and timely reports.

p. Participates in monitoring, analyzing and utilizing program evaluation data to

promote quality of care and position hospital for success.

q. Works closely with finance in order to facilitate Utilization Management

program.

r. Maintains good working relationships with other hospital departments,

participates in hospital meetings and serves on hospital committee as requested.

Knowledge, Skills and Abilities:

ï‚· Language Skills: Able to communicate effectively in English, both verbally and in

writing.

ï‚· Skills: Basic computer knowledge

Education and Experience:

ï‚· Current Louisiana Licensure as RN. Fifth year college or university program

certificate; or two to four years related experience and/or training; or equivalent

combination of education and experience. Knowledge of basic bookkeeping, office

procedures, and electronic billing procedures. BCLS - required.

OSHA:

I-Position is considered to have opportunity for routine exposure to blood borne pathogens in

the normal performance of job duties.

II- Position is considered to have occasional opportunity for exposure to blood borne

pathogens in the normal performance of job duties.

III-Position is considered to have no occupational exposure to blood borne pathogens in the

normal performance of job duties