The Case Manager has the responsibility to identify, assess, plan, coordinate, implement, monitor, and evaluate options and services for individuals requiring case management services. The goal of the case manager is to provide quality, cost-effective outcomes for the client through collaboration and communication with the client, the family, the physician, and other members of the healthcare team.
Responsibilities Include The Following

• Processes the case utilizing the client's outcome management model and tools
• Obtains written authorization for case management services as well as release of information
• Assesses the client/family to identify their strengths and resources; problems; psychosocial, financial, and medical history; current status; diagnosis; prognosis; functional status; goals; current treatment plan; and needs
• Develops a plan of care with Paradigm's model through interdisciplinary collaboration, which identifies realistic short- and long-term goals
• Identifies, secures, and coordinates the services and resources to implement the plan
• Monitors services being provided for continued appropriateness and reports to Paradigm and insurance carrier
• Evaluates the client's progress, the plan, and the appropriateness of the services provided, with modifications as necessary
• Provides ongoing instruction to the client and family regarding the injury/disease process, treatment options, and present care
• Promotes the client's/family's self-advocacy skills to achieve maximum self-sufficiency
• Has knowledge of the benefit package as well as all available funding sources and systems of care and coordinates with the payer for authorization of payment
• Provides for in-depth reporting of outcomes encompassing clinical, functional, financial, and customer satisfaction areas
• Demonstrates effective, accurate, and timely verbal and written communication in all work situations
• Identifies and discloses all situations which might result in exposure to legal liability and/or are indicative of poor quality care negatively affecting the client
• Frequently requires travel to patient appointments.
• Performs other related duties as assigned in accordance with the necessary job function

QualificationsEducation and/or Experience:

• Registered nurse
• BSN preferred
• CCM or equivalent certification
• Three years or more of related experience and/or training or an equivalent combination of education and experience