Case / Care Manager Job Description
Case / Care Manager Duties & Responsibilities
To write an effective case / care manager job description, begin by listing detailed duties, responsibilities and expectations. We have included case / care manager job description templates that you can modify and use.
Sample responsibilities for this position include:
Case / Care Manager Qualifications
Qualifications for a job description may include education, certification, and experience.
Licensing or Certifications for Case / Care Manager
List any licenses or certifications required by the position: BLS, CPR, PHN, AHA, CCM, ACM, CWOCN, CWON, HP, CM
Education for Case / Care Manager
Typically a job would require a certain level of education.
Employers hiring for the case / care manager job most commonly would prefer for their future employee to have a relevant degree such as Bachelor's and Master's Degree in Human Services, Education, Social Work, Health, Psychology, Nursing, Management, Leadership, Graduate, Counseling
Skills for Case / Care Manager
Desired skills for case / care manager include:
Desired experience for case / care manager includes:
Case / Care Manager Examples
Case / Care Manager Job Description
- Contacts patient within 48 hours of discharge assuring proper support and services are in place to make a full recovery (i.e., equipment, home health, other services, transportation)
- Specific issues may include educating newly diagnosed patients about the disease and treatments
- Working independently to deliver quality healthcare to their patients
- Providing a variety of specialized services, such as Simple to Complex Wound Therapy, Post-Surgical Care Management, and Ostomy Care Management
- Screen patients for Level of Care Inpatient, Observation, Emergency and other outpatient services
- Coordination of Care with Interdisciplinary team
- Resource Management- including capturing Avoidable Days, over utilization of services
- Develop and document Assessment, Patient Progress Note and Transitional Care Plan
- Retrospective reviews when needed for short stay admissions
- Active participation with insurance and physician to avoid denials and/or work to reverse negative denial decisions from payer
- Must have the ability to work in a matrix reporting system
- Must be knowledgeable of nursing and medical practices and procedures, laws, regulations, and guidelines that pertain to managed care and nursing facilities
- Must possess the ability to plan, organize, develop, implement, and interpret the programs, goals, objectives, policies and procedures, , that are necessary for providing quality care
- Must be able to navigate an electronic health record (EHR)
- Bachelor’s degree in a human services field
- Must have two years of full-time, post-bachelor’s degree accumulated MH/DD/SA experience with the population served
Case / Care Manager Job Description
- Communicate with physicians, transferring hospitals, payers, admitting for authorization prior to transfer
- Prepare PRI, departmental forms, ensure education of patient and family with accurate documentation throughout hospital stay and at discharge
- Active participation in performance improvement, department activities and data collection efforts
- Always maintain a high level of customer service
- Ability to coordinate and facilitate resources for patient care
- Ability/Knowledge regarding documents necessary for placement and coordination of services for patients
- Able to handle on-call situations, respond to trauma, outpatient clinic needs
- Active participation in multi-disciplinary care planning team
- Appropriate, timely and comprehensive documentation on the Medical Record and interdisciplinary form
- Assume responsibility for monitoring, obtaining signatures and documenting in Canopy, the Important Message from Medicare
- Document appropriate and required information in Canopy Software according to Department Guidelines
- Review of Medical Record and patient/family interview to gather appropriate information for comprehensive assessment
- Serves as a patient/family advocate
- Works closely with hospital attorney and physicians as required
- Knowledgeable in InterQual
- Minimum two years (2) direct patient care experience
Case / Care Manager Job Description
- Play a key role in supporting patient programs
- Responsible for proactively managing specific patient populations
- Provide symptom management
- Deliver advanced care planning education
- Provides psychosocial support
- This position will require travel between clinic locations and clinic nursing coverage as needed
- Utilization review and discharge planning for capitated patients who are hospitalized
- Educates students, families and the community, regarding the integrated healthcare services and policies
- Hands off communication
- Manage patient care, to achieve cost-effective utilization of resources through the proactive coordination of services in order to move patients efficiently through the continuum of care
- 3 years of clinical RN experience in the Acute Care Hospital Setting
- Understanding and knowledge of payer eligibility and reimbursement regulations with impact on the continuum of care
- Knowledge and ability to use/refer to community resources for coordination of discharge from acute care and Emergency Department settings
- Ability to mentor and train nursing and clerical staff members
- Master’s Degree in Nursing or Health Care related area
- Current Certified Case Manager (CCM) or Accredited Case Manager (ACM) certification
Case / Care Manager Job Description
- Completes a review of the Plan of Treatment (485) and OASIS documentations to ensure quality care
- Works with the Beacon team to ensure completion of all requirements of the program as outlined by DMAS, including meeting face-to-face with members and ICTs as necessary and appropriate
- When assigned, responsible for components of member assessment and/or ICP formulation
- When assigned, acts as the primary point of contact for members upon program enrollment and is responsible for member engagement through the assessment process
- Completes a comprehensive assessment on each assigned member, utilizing an approved assessment tool.The assessment must be completed within specified timeframes and by assigned priority
- Meets with the individual and his/her guardian or care provider, as appropriate, to complete the assessment, which may take more than one call/visit if the individual’s condition is too fragile/unstable to tolerate a full assessment in one sitting (whenever possible the assistance of a caregiver or family individual will be elicited to complete the assessment in one appointment)
- Communicates with members about their ongoing or newly identified needs at a regular frequency, as defined by policy (at minimum monthly), to include a face-to-face meeting
- Develops and maintains the Plan of Care and makes information related to the Plan accessible to providers and Members as needed and upon request
- Soliciting and complying with the member’s wishes (e.g., advance directive about wishes for future treatment and health care decisions, prioritization of needs and implementation of strategies)
- May require some out-side business hours on call rotation
- At least three years related acute hospital patient care experience is preferred
- A minimum of 1-2 years of pediatric nursing experience
- Exceptions will be considered on a case-by-case basis at each facility by the Director of Care Management in consultation with the Human Resources leader
- RNs employed prior to 4/1/17 are encouraged to obtain a Bachelor's degree or higher degree in Nursing, but obtaining the degre will not be a condition of employment
- Current Basic Life Support Card (BLS) for Healthcare Providers sponsored by the American Heart Association
- Minimum of one year experience within the past three years in an acute hospital setting as Registered Nurse
Case / Care Manager Job Description
- Manage caseload in the program to include home visits, telephone contact and written communication with clients on a monthly basis
- Maintain client records per policies, regulatory, etc requirements
- Perform chart reviews as required
- Communicate continually with patients and families, physicians, care team members, and third-party players to facilitate coordination of clinical activities and to enhance the effect of a seamless transition from one level of care to another across the continuum, including facilitating and participating in patient care conferences
- Procure services and resources for identified patients and families, serving as an advocate to promote achievement of agreed-upon goals
- Serve as a resource and provides education to patients, physicians, and professional staff on levels of care, quality-of-care issues, and regulatory concerns
- Orient and educate clients and sometimes their families by meeting them
- Perform and review client intake assessment and use results to coordinate the completion of the care plan, self-management goals and strategies
- Interview clients to assess client needs, prioritize needs, identify barriers in addressing needs, and strategize to overcome barriers
- Develop interdisciplinary care plan and other case management tools by participating in meetings
- Bachelor's Degree in Nursing (BSN) strongly preferred
- Minimum of 3 years experience in case management, discharge planning, and/or utilization review
- Bachelors Degree in Social Work from a college or university accredited by the council on Social Work Education required
- MSW preferred
- Will consider a Masters Degree in Social Work in lieu of a BSW
- Minimum of three years in inpatient or outpatient setting required