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Case/Care Manager

2 months ago

Wallingford, United States Gaylord Hospital Full time

Gaylord Specialty Healthcare is a health system dedicated exclusively to medical rehabilitation. We provide inpatient and outpatient care for people at every point in their journey from illness or injury to the most advanced state of recovery they can achieve. Our Mission: To enhance health, maximize function, and transform lives. Our values: Integrity, Compassion, Accountability, Respect and Excellence. These values guide us in providing quality patient care and transforming the lives of our patients.

The Case/Care Manager coordinates all health care services required for an organized, multi-disciplinary team approach to management of designated patient populations; initiates discharge planning in a timely fashion, develops and revises individualized discharge plans as indicated by assessment and patient response to treatment; assesses quality, cost-efficient care to ensure patient’s plan of care promotes a safe and timely discharge; evaluates overall plan for effectiveness.Involves the patient and family in the formulation of goals; monitors appropriateness of admissions and continued stay; provides the link between provider and payer organizations, physicians and the community in the transition of patient care through the health care system.

ESSENTIAL DUTIES AND RESPONSIBILITIES include the below. Other duties may be assigned.

  • Assures and facilitates appropriate and efficient utilization of hospital services. Uses nationally recognized criteria in determining whether the patient meets medical necessity for LTACH level of care and takes appropriate action when variances are identified.
  • Provides clinical information to managed care companies in a timely manner. Prevents denials through pro-active intervention with managed care reviewers, physicians and hospital staff. Administers notices of non-coverage to Medicare patients who do not meet medical necessity.
  • Performs comprehensive assessments and reassessments of the patient’s condition and discharge planning needs including the psychosocial, physical, educational and cultural aspects. Works with the clinical team to develop and modify the care plan to meet the needs of the patient.
  • Collaborates with other disciplines in patient evaluation and treatment and initiates referrals appropriately.
  • Initiates discharge planning in a timely fashion, develops and revises individualized discharge plans as indicated by assessment and patient response to treatment. Evaluates overall plan for effectiveness; involves the patient and family in formulation of goals.
  • Meets monthly and quarterly goals for length of stay management.
  • Acts as the principal communicator to the patient, families and external case managers regarding insurance benefits / reimbursement, treatment plan, progress, length of stay and discharge plan.
  • Demonstrates an understanding of level of care criteria and reimbursement factors for home care, rehabilitation, residential treatment and long term care in development of discharge plans. Seeks alternatives to facilitate discharge planning.
  • Provides patients and families support and information about their current disability.
  • Provides education and support to hospital staff regarding community resources, managed care issues, or payment / payer issues.
  • Demonstrates an ability to be flexible, organized and functional under stressful situations. Utilizes critical thinking skills and sound judgment in priority setting and delegation.
  • Practices autonomously, consistent with evidenced-based standards. Pursues personal and profession al growth and development.
  • Other duties as assigned.
Qualifications:
  • Bachelor's degree preferred; in lieu of a Bachelor's degree, 4 – 6 years of hospital experience preferred
  • A minimum of 2 years of acute care clinical experience required
  • Acute care case management, home care and/or long term care experience preferred
  • Current CT RN license required
  • Professional certification in Case Management or eligibility preferred


WORK SCHEDULE: Full-time, Monday - Friday, days

We Are An Equal Opportunity Employer – M/F/D/V