Case Manager-Inpatient Rehab

Overview

The Case Manager coordinates care for rehabilitation patients with transitional care planning, psychosocial and functional status assessment, patient advocacy and patient/family education. This individual collaborates with other case managers, health care disciplines and patient financial services to provide a comprehensive plan of care in accordance with established guidelines.

1. POSITION QUALIFICATIONS

1. Licensure/Certification

1. BSN, MSN, BSW, MSW
2. BLS Certification
3. Case management Certification preferred

2. Experience

1.  At least 3 years caring for patients including discharge planning and assessment, reimbursement mechanisms, case management principles across the continuum of service awareness of community resources.
2.  Case Management utilization and review
3.   Knowledge of Rehabilitation preferred. 

2. Essential Functions

1. Coordinates patient care throughout the inpatient stay

• Collaborates with the healthcare team in evaluating the appropriate use of resources.
• Collaborates with rehab leaders for progress towards departmental improvement goals relative to length of stay (LOS) and cost per case.
• Coordinates with the physicians and healthcare team to identify patient goals for treatment and desired outcomes.
•  Leads Care Conference as requested.
• Evaluates discharge needs upon admission ensuring each patient has a complete discharge plan.
• Participates in snap huddles to anticipate barriers to discharge and align care team towards discharge goal.
• Updates Care Port as appropriate.
• Assists patients with UR letters / appeals and patient MOON as outlined by CMS.   
• Serves as a member of clinical pathway teams that are pertinent to area of expertise.

2. Engages in utilization management activities appropriate to the patient’s level of care.

• Maintains informed status of reimbursement plans, requirements, and guidelines for hospitalization and alternate level of care services. Communicates status to healthcare team.
• Contacts attending physician and other healthcare providers whenever any additional information is needed for assessments, care planning, or reimbursement purposes.
• Obtains insurer’s approval for services by providing insurer with pertinent medical information. Ensures progress towards departmental goals for denial management.
• Handles Hospital Issues Notice of Non-Coverage (HINN).

3. Assists patients with transitional care needs.

• Collaborates with healthcare team to determine patient transitional care needs, appropriate level of care, and plan of care.
• Obtains information and serves as a resource for discharge issues discussed at patient care conference.
• Completes assessment that accurately reflects patient current conditions, situational factors, and transitional care needs.
• Obtains approval from patient insurer for transitional care services, when indicated.
• Partners to involve the patient/patient’s support system in discharge plan and needs assessment.
• Allows for any cultural or religious beliefs in providing services and continuity of care.

4. Assesses patient psychosocial status

• Assesses patient (and family) social situation including living arrangements, financial status, support system.
• Considers patient home environment, support system and financial issues when determining feasibility of arrangements.

5. Provides patient and family with education, information, and referral services.

• Maintains current knowledge of community resources and programs, including eligibility criteria and services available.
• Understands healthcare system and directs patient/family to appropriate staff when indicated.
• Provides patient/family with relevant information about insurance coverage, support and community services, and the health care system. Coordinates with the healthcare team to provide education relative to patient illnesses.
• Communicates appropriately and professionally with patient based on age-appropriate development and cognitive abilities.

6.    Documents patient medical records, computer system, and departmental records.

• Completes chart notes accurately and timely, per departmental/hospital protocol.
• Ensures all records are up to date and legible.
• Ensures all records are organized and available in cross coverage situations.

7. Actively participates in Performance Improvement (PI) processes.

• Ensures appropriate utilization of resources by using financial and clinical data to determine progress towards departmental goals and objectives.
• Identifies, documents, and reports variances, quality, cost, and risk issues related to patient plan of care. Communicates variances to management.
• Supports and participates in the review and modification of utilization management policies, procedures, and processes.

8. Serves as an advocate for patient and families

• Facilitates communication between patient, family, and other members of healthcare team and ensures that patient/family wishes are understood.
• Promotes patient self-determination by keeping patient abreast of choices and implications of those choices.
• Recognizes patient decision-making capacity and encourages patient to verbalize desires and need.
• Recognizes cultural and religious beliefs of patient and acknowledges the impact these have on the patient.
• Attends education offerings (in the hospital and the community) that enhances individual’s knowledge and skill development.

1. Performs other duties necessary to the organization as needed.

• Ensures appropriate utilization of resources.

10. Continuing Education

• Completes unit and departmental annual skills checklists.