Case Manager

Job Summary

The Case Manager-Professional coordinates and facilitates the care of patients throughout the continuum of care in an acute-care hospital setting. The role involves effective collaboration and communication with Interdisciplinary Care Transitions (ICT) team members, physicians, patients, and families to ensure optimum utilization of resources, service delivery, and compliance with external review agencies. The Case Manager-Professional conducts comprehensive assessments, develops care plans, implements and evaluates interventions to enhance patient management, promote continuity of care, and support cost-effective outcomes.

Essential Functions

• Coordinate clinical and psycho-social activities with the Interdisciplinary Team to provide comprehensive care coordination and discharge planning.
• Conduct comprehensive biopsychosocial assessments to provide timely and safe discharge planning, referring cases to Social Workers as applicable.
• Monitor patient care to ensure effective coordination and efficient care facilitation from admission through discharge.
• Perform medical necessity reviews and assess the appropriateness of clinical resource utilization.
• Develop and implement discharge plans that address both immediate and post-discharge needs, coordinating with community resources as needed.
• Serve as a patient advocate, promoting informed decision-making and maximizing patient and family understanding of care plans.
• Participate in interdisciplinary patient care rounds and conferences to review treatment goals and optimize resource utilization.
• Maintain accurate documentation of patient care, discharge planning activities, and third-party payor reviews according to regulatory requirements.
• Stay informed about government and non-government payor practices, regulations, standards, and reimbursement policies.

Knowledge/Skills/Abilities/Expectations

• Knowledge of government and non-government payor practices, regulations, standards, and reimbursement.
• Knowledge of Medicare benefits and insurance processes and contracts.
• Excellent interpersonal, verbal, and written communication skills to effectively interact with patients, families, and healthcare providers.
• Strong organizational and critical thinking skills to manage multiple patient cases simultaneously.
• Basic computer skills, including proficiency in Microsoft Office Suite and electronic medical records systems.
• Ability to work collaboratively within a multidisciplinary team to achieve optimal patient outcomes.
• Must maintain regular attendance and adhere to hospital policies and procedures.

Education

• Postsecondary (Certificate, Diploma, or Program Graduate) – RN or LPN/LVN Diploma, Associate’s, or Bachelor’s Degree from an accredited school of nursing (required) OR

• Bachelor’s Degree or higher in Social Work (BSW or MSW) (required)

Licenses/Certifications

• LPN or LVN – Licensed Practical or Vocational Nurse – State Licensure in the state of practice upon hire (required) OR

• RN – Registered Nurse – State Licensure and/or Compact State Licensure in the state of practice upon hire (required) OR

• LCSW – Licensed Clinical Social Worker or LSW in the state of practice upon hire (required)

Experience

• One (1) or more years of experience in a healthcare setting, with experience in case management, utilization review, or discharge planning (preferred)

• Prior experience in acute care, medical/surgical, or ICU/CCU settings (preferred)