Case Manager

JOB PURPOSE:

The Case Manager’s functions are to make readily available to the patient, their families and/or guardian, special services to facilitate adjustment of these individual’s continuity of care post discharge. The Case Manager oversees the effective coordination of admission and discharge planning, case communications, interdisciplinary team meeting, conferencing, insurance relations and assurance through managed care systems. The Case Manager is also responsible for the authorization of appropriate services for continued stay through discharge. The Case Manager assures regulations regarding the patient rights are fulfilled. Any position that has direct patient care is considered to be safety sensitive by Avem Health Partners’ standards.

ESSENTIAL FUNCTIONS INCLUDE BUT NOT LIMITED TO:

• Conducts and documents a comprehensive initial assessment within 24 hours of admission to identify potential problems of patient and/or family during admission and post discharge.
• Identifying the reason for admission, existing co-morbidities or conditions that increase the risk for readmission.
• Assess the ability of the patient to care for self at current functional level by ensuring support systems are present.
• Identification of psychological and socioeconomic conditions present.
• Gathers pertinent information from medical record and interdisciplinary team.
• Leads and directs Interdisciplinary team meetings weekly relating pertinent information in an attempt to establish attainable goals for the patient.
• Maintains comprehensive progress notes weekly and as needed.
• May assist the social worker in acquiring financial assistance for eligible patients.
• Collaborates with physicians with discussions regarding patient progress, and achievement of expected outcomes, appropriate alternate levels of care when needed, and updating treatment plan.
• Understanding the Medicare/Medicaid/Insurance/Self-pay payor sources regarding provisions and regulations.
• Understands the legal and ethical issues pertaining to HIPAA.
• Ensures computer and patient record security.
• Demonstrates the ability to recognize families or situations at high risk for abuse or neglect including physical and/or sexual abuse, physical and/or medical neglect, and emotional maltreatment, by initiating the appropriate referrals to social services, APS, and chaplain/ministerial services.
• Collects QI data for statistical purposes to aide in outcome measurement.
• Build relationships and coordinate with payor sources to assure proper reimbursement for hospital provided services, promote costs attentive care via focus on resource management within the plan of care.
• Other duties as requested within scope of practice.

BEHAVIORIAL STANDARDS:

• The individual must support the mission, vision, and goals of Avem Health Partners and serve as a role model within the company.
• Exhibit positive customer service behavior in every day work interactions.
• Demonstrate a courteous and respectful attitude to internal workforce and external customers.
• Communicate accurately and appropriately.
• Handle difficult situations in a discreet and professional manner.
• Hold self-accountable for professional practice.
• Interact and cope effectively with diverse populations in stressful situations resulting from trauma and illness.
• Participate in performance improvement activities utilizing principles to support and improve patient care.
• Demonstrate knowledge of unit goals and is active in committees and projects to achieve these goals.
• Keep current with literature regarding changing practices, interventions and best practices in patient care.
• Assume responsibility for seeking out educational and professional opportunities for personal learning needs and growth as well as meeting mandatory education requirements.
• Act as a preceptor as requested.
• Demonstrate excellent work attendance and attend and actively participate in a variety of meetings and training sessions as required.
• Adhere to the Avem Health Partners Code of Conduct and Standards of Behavior. Complies with established policies and procedures and all health and safety requirements.

EDUCATION/QUALIFICATIONS:

• Graduate of an accredited school of nursing; BSN preferred.
• Three (3) years case management experience.

CERTIFICATION/LICENSURE:

• Current RN license from the State of Oklahoma Board of Nursing.
• Current BLS (or obtained within 30 days of hire).
• Certified Case Manager (CCM) certification preferred.

PHYSICAL REQUIREMENTS:

• To perform this job successfully, an individual must be able to perform each essential job duties satisfactorily. The requirements listed are representative of the knowledge, skill, and/or ability required. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions. Such accommodations must be requested by the employee/applicant to be considered.
• This job requires visual abilities, auditory abilities, must be intact to perform duties.
• Constant sitting is required.
• Frequent standing and walking is required.