Case Manager RN or SW

Job Details

• Coordinates and provides care that is safe, timely, effective, efficient and patient centered.
• Admits new patients and determines patient's requirements and needs.
• Knowledgeable about medical terminology, appropriate levels of health care treatment modalities and the health care delivery system.
• Promotes quality and cost-effective interventions and outcomes.

• Handles case assignments, creates/reviews/updates discharge plans, reviews case progress and determines case closure.
• Establishes treatment programs by setting schedules and routines, coordinating services provided and arranging resources including external healthcare organizations and facilities.
• Records case information, fills necessary forms and participates in data collection to show effectiveness.
• Documents discharge plans according to the Medicare Conditions of Participation and DNV standards.
• Responsible for monitoring utilization and if necessary, discussing utilization of services with providers and recommending alternative options when appropriate.

• Helps patients to achieve the maximum possible wellness and autonomy through self-determination.
• Provide emotional support to patients and families.
• Assess and addresses motivational and psychosocial issues.
• Establishes treatment programs by setting schedules and appointments, coordinating services being provided and arranging resources.
• May participate in the Transitions of Care Follow Up Call program as assigned.
• May, based on Licensure, provide Counseling and/or Crisis Intervention for patients/families.

• Develops effective working relationships and cooperation with the medical team throughout the case management process.
• Presents cases at interdisciplinary care conferences.
• Communicates regular updates to the appropriate caregivers.

• Will participate in performance improvement programs and quality outcomes data for patients.
• Assist with data collection, health outcomes reporting and clinical audits.
• Will promote quality service adhering to compliance policies, privacy, security and confidentiality policies and organizational standards set forth in the Code of Conduct.
• Maintains compliance with Regulatory Standards and State Statutes.

• Connects patients with community resources.
• Provides guidance and referrals for patients who need additional community resources to services such as equipment, meals, mental health, counseling for substance abuse treatment, abuse/neglect, domestic violence, etc.
• Ensures freedom of Patient Choice and documents same via the Patient Choice Letter.