What are the responsibilities and job description for the CASE MANAGEMENT - MEDICARE position at Collom & Carney Clinic?
CASE MANAGEMENT - MEDICARE
Strategically manage services for specified patient population. Provide a focus on wellness, prevention, and efficient care through the coordination with patients, their families, and physicians. The education of the patient and his/her family will be incorporated into the care plan after careful assessment of the patient’s knowledge base, home life, and post-acute resources. The Case Manager will play a vital role in the clinical, financial and education of patients and will ensure these aspects are all considered simultaneously throughout the continuum of care. The Case Manager will ensure the patient receives the right services at the right level of care and will assist the patient in navigating their own care at an optimum level.
1. The ability to demonstrate knowledge and effectiveness of Case Management principles in the following health care areas; processes, relationships, management, community resources, service delivery, psychosocial interventions and all other areas of Case Management.
2. Design and develop a process of identifying patients in need of ongoing surveillance, tracking and screening for development of further complication and follow-up in partnership with the health care team.
3. Coordinates with patient, families, and health care teams to develop a mutually agreeable plan of care that meets the needs of the individual patient.
4. Research the healthcare environment for innovative concepts and best practices and develops practical applications for quality improvement.
5. Develop and maintain processed to improve transitions of care, focusing on hospital and ED discharges as well as post acute care facility usage and interactions with specialists.
6. Develop and maintain processes measuring the patient experience, clinical quality measures and utilization management that drive the cost of care.
7. Keep patients well informed by telephone and in writing of activities/case summaries.
8. Demonstrate sensitivity to issues and show pro-active behavior in addressing client and patient needs.
9. Promotes health education and provides literature to patients to enhance understanding of a condition, treatment or procedure.
10. Assist patients in addressing questions to their physician.
11. Coordinate services for the patient population having a health risk or chronic condition to include screening and on-going monitoring.
12. Utilize appropriate community health care resources to maximize patients healthcare outcomes.
13. Maintain confidentiality and adhere to HIPAA requirements.
14. Document clinical information completely, accurately and in a timely manner.
15. Other duties as assigned.
1. Current LVN/LPN license.
2. Experience with Medicare population a strong plus.
3. Must possess a working knowledge of CPT/ICD-10 codes.
4. Two – three years experience of utilization or Case Management preferred.
5. Knowledge of managed care principles regarding legal and regulatory requirements and confidentiality preferred.
6. Must have excellent communications and presentations skills.
7. Demonstrates diplomacy and professionalism when dealing with staff or patients.
8. Knowledge of primary care a plus
