Job Description

Summary & Objective

The Case Manager coordinates discharge planning for residents and/or patients and helps manage their healthcare by acting as a liaison between the interdisciplinary team, the physicians and payor as related to their progress and status while in the facility. The Case Manager also assists residents and/or patients in getting access to community resources and programs.

Essential Functions

· Interviews resident and/or patient and completes assessment within 72 working hours, and documents in Medical Record.

· Obtains timely insurance re-certifications and provides weekly updates verbal/written for continued stay authorization and enters into billing software. Utilizes the Trace program when communicating with insurance representatives.

· Attends interdisciplinary team conference to discuss resident and/or patient status.

· Conducts family conference meetings as needed.

· Discharge planning to the community with but not limited to referrals for home health care services, ordering durable medical equipment, arranging outpatient services referrals, referrals to Long Term Care settings, Assisted Living Facility and Skilled Nursing Facility as applicable.

· Educates with patient and/or family of advanced directives if applicable

· Educates patient/resident and/or family on community resources and programs.

· Coordinates and obtains authorization from insurance company for all procedures, appointments and transportation for all HMO residents and/or patients.

· Communicates with patient and/or responsible party when person served is approaching the end of rehabilitative care status and interprets recommendations for continuation of care.

· Provides Important Medicare Letter of Rights to resident and/or patient and/or family and obtains signature on form as warranted within the required timeframe prior to discharge if applicable.

· Provides Notice of Medicare Non-Coverage and Nursing Home Transfer and Discharge Notice to resident and/or responsible party and obtains signature within the required timeframe prior to discharge if applicable.

· Follows Medicare appeal process and keeps log as needed.

· Completes and posts discharge forms.

· Documents resident and/or patient progress notes as needed.

· Serves as a liaison with physician and continuously communicates regarding resident and/or patient’s status and/or concerns.

· Participates in daily management team meetings to discuss patient and/or resident’s status, census changes, and patient and/or resident’s complaints or concerns.

· Conduct follow up phone calls within 72 hours of discharge and utilized worksheet questionnaire.

· Obtain HMO level increases such as IV’s (high cost drugs), special equipment and change in skilled needs if applicable.

· Communicate and coordinate with third party bundle payment programs if applicable.

*Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of the position.

Other Duties

· Promotes customer service and hospitality and responds to and adequately resolves complaints or concerns

from patient and/or resident’s or families and informs to the Director, Case Management/Social Services.

· Provides orientation to new employees as needed.

· Maintain your required license, certifications and mandatory skill updates.

· Comply with all policies, local, state and federal laws and regulations.

· Perform other duties as assigned.

Requirements

Knowledge & Experience Requirements

· Clear and Active Registered Nurse or Licensed Practical Nurse license to practice in the state of Florida, Social Work or related clinical field

· CPR certification

· 1-3 years of experience in a Health Care Facility

· Must have knowledge of computer office/clinical software

· Must be able to read, write and understand the English language.