Integrated Case Manager

This position plans and coordinates the discharge of rehabilitation patients. This position collaborates closely with the Interdisciplinary Team to manage length of stay (LOS), resource utilization, continuity of patient care while maintaining costs. This position is also responsible for coordinating services to patients and families including emotional support, advocacy as appropriate, and financial information. The purpose of the Rehab Case Management program is to promote quality of care, cost effective patient outcomes, efficient resource utilization, while meeting the emotional needs of the patients and families as well as the expectations of the patient, family, referring physicians, agencies, and payer sources.

Activities are accomplished through pre-admission reviews, concurrent and retrospective medical record reviews, and effective discharge planning.

In collaboration with the treatment team, attending physician, and external entities, is responsible for coordinating and directing the planning, organization, evaluation, and follow-up of patient care.

Responsibilities include:

• Conducting the pre-admission screening, intake and evaluation for rehab potential and appropriateness for admission to the level of care.

• Scheduling the Interdisciplinary Team Conferences.

• Routine Scheduling of Family Conferences and family conferences on an as needed basis.

• Reimbursement forecasting by determining Rehab Impairment Code (RIC), Case Mix Group (CMG), Average LOS, and other adjusters as appropriate.

• Obtaining prior authorizations, verification of benefits, insurance coverage, and identify payer expectations.

• Identifying patient/family/social/emotional issues to consider in establishing an appropriate discharge plan and optimal patient stay.

• Evaluating documentation of patient progress, continued stay and level of care needed,

• Directing the discharge planning process.

• Promoting the utilization of resources in compliance with external review criteria and payer expectation.

• Facilitating exchange of pertinent information through the continuum of care.

• Tracking of patients based on the reimbursement and LOS forecasting.

KNOWLEDGE, SKILLS & ABILITIES:

Thorough working knowledge of Medical and Rehabilitation Terminology:

Demonstrated knowledge of:

• Case Management principles and methodology

• Knowledge of Levels of Care (Acute care, Critical Care, Acute Rehab, SNU, Subacute, Outpatient, Home Health, Day Tx.)

Thorough working knowledge of:

• Government, county, private, and workers compensation funding sources.

• Eligibility criteria.

• Criteria for determining level of care, and familiarity with managed care (HMO, PPO, PSO, and capitation).

Demonstrated ability to:

• Communicate effectively with health care professionals and external case managers.

• Identify obstacles to patient progress and barriers to discharge.

• Problem solves with medical team to remove such barriers.

• Maintain professional relationships; work effectively and collaboratively with other members of the medical team.

• Actively pursue continuing education and training opportunities in case management.

• Ability to maintain knowledge regarding standards of care, case management /utilization principles and approaches, Social Services, and discharge management.

• Ability to maintain confidentiality regarding the medical record.

• Understand insurance and payer requirements.

• Demonstrate the knowledge and skills necessary to provide care based on physical, motor/sensory, psychosocial, and safety appropriate to the age.

• By nature of current license for RN, LSW, PT, OT, or Speech competency is demonstrated for ability to perform job duties.

This position does provide patient care.

The foregoing description is not intended and should not be construed to be an exhaustive list of all responsibilities, skills and efforts or work conditions associated with the job. It is intended to be an accurate reflection of the general nature and level of the job.

Name

Description

Education:

Must have working-level knowledge of the English language, including reading, writing, and speaking English. Bachelor’s or master’s preferred.

Experience:

Minimum of one-year in hospital setting required.

License(s):

Ability to obtain and maintain a State of Nevada Registered Nurse, and/or Social Worker license.

Certification(s):

Certification in Case Management (CCM), Rehab (CRRN), or Managed Care (NMCC) strongly preferred. Current AHA CPR certification required.

Computer / Typing:

Must be proficient with Microsoft Office Suite, including Outlook, PowerPoint, Excel, and Word and have the ability to use the computer to complete online learning requirements for job-specific competencies, access online forms and policies, complete online benefits enrollment, etc.