As a Case Management Professional, you will be a pivotal coordinator and advocate, guiding patients through complex healthcare journeys to optimize outcomes and well-being.
Every day, you will assess patient needs, develop individualized care plans, facilitate seamless transitions, and coordinate resources. You'll educate patients and collaborate with multidisciplinary teams to ensure continuity of care and prevent readmissions.
To be successful in this role, you will possess exceptional assessment and coordination skills, strong communication, and a deep understanding of healthcare systems, with an empathetic approach to patient advocacy.
- Implements the discharge plan of care developed by the nurse Case Manager. Works independently, interviews patient/responsible party to determine preference and provide information on financial responsibilities to support the client's care. Works with facilities and vendors to obtain services / placement acceptance. Provides benefits and patient preferences with the patient/family care team, insurance companies and community based support services according to the discharge plan. Sends effective linkages with community resources and alternate services for clients with limited benefits or personal resources. Sends all the necessary referrals and authorizations as identified by federal, state and local insurance regulatory agencies. Facilitates the referral and transfer of a patient to an appropriate lower level of care such as Skilled Nursing or home with Home Health and obtains an attending physician to cover as needed.
- Monitors the plan of care and coordinates the delivery of services. Identifies potential problems and brings them to the attention of the Case Manager to prevent and/ or resolves variances to the case management plan. Communicates with Case Manager, client/family and/or payer to resolve conflicts regarding the treatment plan. Communicates with Case Manager to expedite timely resolution of situations such as client concerns or need for referrals to expedite the discharge plan. Issues denials to client / responsible party following regulatory guidelines and facility protocols. Informs client / responsible party of right of appeal and the appeal process. Reviews and processes appeals and denials.
- Documents information clearly and accurately to promote communication with patients, caregivers, vendors, and customers. Maintains accurate, current, legible client records, according to department and entity standards. Identifies and refers quality and risk management concerns to appropriate level of case management staff for corrective action plans and trending. Complies with confidentiality policies, HIPAA regulations, and department standards when transmitting patient information to Dignity Health affiliate agencies or other vendors as needed for patient placement and referral. Provides clerical support as needed including copying, faxing, and data entry. Completes forms required for department reporting and analysis.
- Actively participates as Case Management team member to achieve department goals and objectives. Attends regularly and actively participates in daily team huddles and Case Management department meetings. Positively contributes to team decision making process in planning daily priorities, resolving barriers to discharge plans and seeking creative solutions to resolve conflicts. Collaborates with team members on interdependent tasks. Demonstrates both initiative and flexibility working with Physicians, Case Managers, Assistants and other staff. Cross trains and provides coverage to other department functions such as Assistant, Representative or Clerk as needed to meet operational needs. Actively shares knowledge and information with team members.
