Job Details for 4173 - Clinical Case Manager
FLSA STATUS: Exempt
Under general supervision; performs work of moderate difficulty in providing professional clinical case management to patients and/or clients; performs related work as required.
DISTINGUISHING FEATURES OF THE CLASS
An employee in this class provides professional clinical case management to patients and/or clients by proactively coordinating timely and accurate communication regarding their benefit level, service needs, treatment status and discharge plan. General supervision is received from the assigned department head or supervisor, depending on area of assignment.
ESSENTIAL DUTIES AND RESPONSIBILITIES
The list of duties and responsibilities is illustrative only, and is not a comprehensive listing of all the duties and responsibilities performed by positions in this class.
• Reviews, assesses and documents benefit, medical, social and financial information in an accurate and appropriate manner
• Establishes contacts with family, payer and other internal and external customers
• Develops and coordinates safe, effective, realistic and timely discharge plans in coordination with patient, family and team and prepares discharge papers
• Conducts Minimal Data Set (MDS) interviews and completes assigned sections of MDS 3.0 including assigned Care Area Assessment (CAA)
• Completes initial assessment, social history, and discharge assessment
• Schedules and coordinates care plan meetings
• Facilitates weekly interdisciplinary discharge planning meeting and then communicates changes to patients and families as appropriate
• Maintains and updates discharge calendar for interdisciplinary coordination of services
• Assists new patients/families with the completion of admission paper work
• Develops and maintains current documentation in the medical records regarding status of discharge plans, case management authorizations, utilization review and family issues related to discharge, mood, behavior issues, and progress notes
• Completes designated portion of patient functional profile and other routine statistical reports
• Obtains and documents authorizations for continued stay, procedures and tests ordered as medically necessary, per payer requirements
• Coordinates completion of letters of medical necessity
• Assists in conveying nursing, medical, psycho-social and or benefit/financial information to discharge referral agencies
• Assists in facilitating a smooth transition to alternate levels of care or discharge destination.
• Monitors length of stay of all cases for evidence of medical necessity
• Acts as patient advocate utilizing internal and /or community resources to meet the patient’s medical, social and/or financial needs to be successful at the discharge destination
• Conducts resident interviews for abuse allegation investigation
• Reviews patient documentation and status for continued progress, goal achievement and justification of current care level against in-house criteria
• Informs the interdisciplinary team of benefit issues or denials issued by external case management, utilization specialist, physician or committee
• Maintains regular attendance and punctuality
NON-ESSENTIAL DUTIES AND RESPONSIBILITIES
• Adjusts work assignments and schedules in the event of an emergency to participate in emergency preparedness, response, and recovery activities as assigned.
• Depending on assignment may maintain required emergency management training, licensure and/or certifications.
• Performs related duties as required or assigned within job classification.
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and /or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions.
• Assessment methods and procedures
• The availability of community healthcare and social service resources
• Professional standards, practices and techniques in the field of case management
• Medical and psychological terminology, behavior patterns and illness effects
• Current office practices, procedures and equipment
• County policies and procedures
• Applicable federal, state, and local laws, rules, regulations, codes, and/or statutes
• Understanding problems, needs and motivations of patients and/or clients and families
• Dealing effectively with others
• Exercising sound judgment
• Using computer hardware and software including word processing, spreadsheets, databases, email, etc.
• Applying an acquired knowledge of procedures, rules, regulations and services applicable to the assigned office
• Utilizes the computer to communicate information.
• Keeping with current standards and practices of the social work profession
• Communicate effective verbally and/or in writing
• Manage projects and multiple priorities simultaneously
• Establish and maintain effective working relationships with department and division staff, other departments and others, such as vendors
• Communicate and use interpersonal skills to interact with coworkers, supervisor, the general public, etc. to sufficiently exchange or convey information and to receive work direction
• Ensure compliance with applicable federal, state, and local laws, rules, and regulations
• Convey excellent oral and written communication
• Work effectively under stress
• Maintain confidentiality
• Work within time constraints and/or deadlines
EDUCATION and/or EXPERIENCE
Completion of a Master’s degree in Social Work, Psychology, or a related human service field and two (2) years of experience in a sub-acute health care environment within a skilled nursing facility working with Medicare/Medicaid populations; or, an equivalent combination of education and experience sufficient to successfully perform the essential duties of the job such as those listed above.
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of the job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Light Work: Exerting up to 20 pounds of force daily and/or a negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects, including the human body.
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
The work environment for this position regularly includes working with residents and attending to their daily needs. The noise level in the work environment is moderate to quiet.
CERTIFICATES, LICENSES, REGISTRATIONS