Case Manager

4 months ago

Houston, United States Nexus Health Systems Ltd Full time
Job DescriptionJob Description


The Case Manager is responsible for directing and coordinating the functions and activities of health care services delivery and discharge planning with the multidisciplinary team. The Case Manager facilitates communication and coordination between the health care team members involving both the resident and family in the decision-making process. Activities include encouraging appropriate use of health care services and striving to improve quality of care and maintain cost-effectiveness on a case-by-case basis. The Case Manager is responsible for establishing a positive relationship with payer sources and initiating necessary documentation for re-authorization of the resident's continued stay.

JOB SPECIFIC RESPONSIBILITIES:

• Assembles treatment team to conduct admissions conference with patient and/or support persons.

• Assures a secure and comforting welcome to patient/support person upon admission.

• Upon patient admission, contact external payor source case manager/representative of the patient's actual admission and reviews schedule for clinical updates.

• Completes admission forms as required on each assigned patient.

• Uses admission profile information to prepare for discharge planning and updates profile as patient/family context changes.

• Liaisons with patient's attending physicians and medical staff to ensure patient's medical needs are met.

• Liaisons with treatment team members to ensure patient's treatment is accurately focused on patient needs.

• Coordinates with medical staff to attend weekly team rounds and arrange for diagnostics, equipment, supplies, or medicals services as ordered.

• Completes Clinical Pre-assessments on patients as needed.

• Provides input to the Administrator regarding Case Management issues.

• Provides third-party payor sources with appropriate clinical updates as per the agreed-upon reporting schedule.

• Presents a positive and helpful working relationship with all external case managers/representatives and community agencies, demonstrating effective internal case management.

• Acquires appropriate information to address payor denials necessary to receive payment due.

• Maintain initial and ongoing documentation in the medical record regarding patient status related to treatment progress, family issues, estimated length of stay, and discharge needs.

• Arranges proper and timely discharge planning for all patients in coordination with family or support persons.

• Coordinates input and feedback from a multidisciplinary team, patient's family, or support persons for discharge needs from admission to actual discharge.

• Acquires necessary community resources to meet the patient's needs before discharge.

• Coordinates discharge with patient's payer sources and community services to ensure a safe, timely, and effective discharge is achieved.

• Verifies community services have been arranged to ensure a timely and uninterrupted discharge transition of a patient is to the most appropriate setting.

• Resolves patient family or support person's complaints or concerns to appropriate team members and follows up to ensure resolutions are acceptable to all parties.

• Exhibits a positive professional demeanor to residents and relevant parties, offering constructive communication, cooperation, and assistance to ensure a satisfactory patient stay of treatment.

• Provides effective assistance and positive relations with co-workers that demonstrate collaborative multidisciplinary treatment team approach to resident or program problem-solving issues.

• Provides timely information/feedback to the designated supervisor on any resident/family/support person/payor source relevant issue that could jeopardize the patient's treatment, family/support person/payor sources, or discharge planning issue.

• Communicates with the manager and department directors to ensure team-focused patient-centered care.

• Performs other duties as assigned.

POSITION QUALIFICATIONS:

EDUCATION:

• Bachelor's Degree in health care field preferred

EXPERIENCE:

• Experience in pediatric case management

• Strong background in healthcare

• 3-5 years direct pediatric patient care experience

LICENSURE/CERTIFICATION:

• Current license as a Registered Nurse or Social Worker in the state of Texas.

• Current AHA BLS certification.



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