Case Manager

What You Will Do:

• I. General Summary

Under general supervision of the Manager of Case Management, the Case Manager provides care coordination and discharge planning for an assigned patient case load. The Case Manager will assess individual patient’s needs, coordinate and implement plans of care and monitor and evaluate outcomes across the continuum of care.

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  II. Principal Responsibilities and Tasks
  
  • The following statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not to be construed as an exhaustive list of all job duties performed by personnel so classified.

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  Assesses assigned patients and integrates psycho social assessment within the multidisciplinary team. Works collaboratively with the multi-disciplinary team to determine potential and actual risks to recovery and formulates plan to determine appropriate level of care upon disposition from the acute care setting.
• Accountable for developing and coordinating the implementation of Discharge Plan A and alternative Plan B, including documentation in the medical record
• Multidisciplinary collaboration with physicians, nursing, social work, and multiple disciplines, departments, payers, and agencies to eliminate barriers to efficient delivery of care in the appropriate setting
• Facilitates timely transition plan
• Active leadership role in the ongoing management of inpatient length of stay and the reduction of readmissions across the organization
• Integrates work with ambulatory and clinic transitional case managers
• Leadership in care management rounds, interprets, and integrates the patient’s story into the overall multidisciplinary plan of care
• Develops and implements corrective action plans for resolution of complex problematic issues and elevates to leads as necessary
• Ensures authorizations have been completed in a timely manner
• Collaborates with Utilization Management and synthesizes information in order to reduce avoidable days
• Collaborates with Physician Advisor for complex issues
• Guides physicians in appropriate clinical documentation
• Actively participates in clinical performance improvement activities as assigned
• Builds a network of positive working relationships that advocate for the patient
• Remains current on clinical practice and protocols impacting clinical reimbursement

What You Need to Be Successful:

III. Education and Experience

• Bachelor’s in Nursing or active pursuit of BSN required. Licensure as a Registered Nurse in the state of Maryland required. Certified Case Manager (CCM) is preferred.
• One year of experience in case management and knowledge of payer mechanisms is preferred. Two years experience in acute care required, four years clinical healthcare experience preferred. Additional experience in home health, ambulatory care, insurance industry and/or occupational health is preferred.

IV. Knowledge, Skills and Abilities

• Knowledge of managed care, discharge planning and case management is required.
• Highly effective verbal and written skills are required.
• Strong communication skills, self confidence and experience dealing physicians required.
• Excellent analytical and team building skills, as well as the ability to prioritize and work independently is required.
• Must possess the ability to work collaboratively with other disciplines.
• Ability to work with Hospital/Case Management related software programs required.
• Ability to demonstrate knowledge and skills necessary to provide care appropriate to the patient population(s) served. Ability to demonstrate knowledge of the principles of growth and development over the life span and ability to assess data reflective of the patient's requirements relative to his or her population-specific and age specific needs.

We are an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, disability, protected veteran status, age, or any other characteristic protected by law.