Clinical Case Manager

Description

General Description:

This position is responsible for the collection and coordination of clinical data to facilitate the efficient delivery of care for our short stay residents/patients.

Essential Job Functions:

1. Conducts clinical review of patient’s medical records to determine medical necessity for continued stay.
2. Provides clinically-based case management, discharge/planning, and care coordination.
3. Has a knowledge of Residents’ Rights and facility Abuse Policies and Procedures;
4. Assess risk factors such as secondary and tertiary diagnoses that may increase risk of hospitalization.
5. Communicates specific patient care needs to Interdisciplinary Team to ensure optimal care and outcomes.
6. Provide education and information to referral sources, patients and families regarding programs and services.
7. Provides requested documentation to insurance company in a timely manner.
8. Performs other job related duties as directed by supervisor.

Key Characteristics:

1. Demonstrates neatness, accuracy and dependability.
2. Contributes, develops and carries out new ideas.
3. Demonstrates an ability to work with others.
4. Ability to work independently.
5. Ability to work in cost and time efficient manner.
6. Teaches skills and knowledge to new staff.
7. Wears appropriate clothing/uniform.  Appearance is neat and well kept.
8. Relates well with residents; is friendly and pleasant.
9. Demonstrates good safety habits­—uses equipment appropriately.
10. Attendance/punctuality—comes to work when scheduled and on time.
11. Attends/completes required in-services.

Minimum Qualifications:

1. Current Connecticut RN or LPN  licenses
2. Good interpersonal skills
3. Sensitive to the unique needs of the geriatric population
4. Must have an understanding of DPH regulations.
5. Must have an understanding of Patient Driven Payment Model, Medicare, Medicaid and Managed care Insurance
6. Able to handle multiple deadlines, strong communication and problem solving skills; must work collaboratively as a member of a team.
7. Must be familiar with RAC-CT.
8. Provides regulatory notices in a timely manner including nomnc and snfABN per cms guidelines.
9. Participates in resident care plans weekly meetings and 72 hour meetings.
10. Available to assist with KEPRO appeals including nights and weekends.
11. Maintain current with education-keeping up with the changes to this department.

Physical Requirements:

• Must be of good physical and mental health.
• Must utilize good interpersonal communication skills in dealing with residents, their families, and members of the interdisciplinary team.
• While performing the duties of this job, the employee is regularly required to stand, walk, use hands to finger, handle or feel, reach with hands and arms,talk, hear and listen, taste and smell.
• While performing the duties of this job, the employee is required to sit, climb or balance, stoop, kneel, crouch or crawl.
• Must be able to read, write, and speak in English in a legible and understandable manner.
• Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Equipment to be used:         

• All relevant nursing and medical equipment

Computer, fax, copier,calculator, telephone, walkie-talkie

Qualifications

Key Accountabilities (with or without reasonable accommodation):

1. Demonstrates ability to accurately document, in a timely fashion, regarding status and degree of resident progress.
2. Demonstrates interest and expertise in education staff and families in matters regarding appropriate interventions.
3. Demonstrates an ability to use computer, fax, copier, calculator, telephone, and walkie-talkie.
4. Independently fulfills the ongoing requirements for supervised clinical hours and hours of continuing education in order to maintain the designation of Clinical Case Manager.
5. Must have a valid and unencumbered CT driver’s license.
6. Must have a vehicle and be able to travel within Connecticut.