SNF Transitional Case Manager
3 weeks ago
The Case Manager for Skilled Nursing Facilities is responsible for the assessment, treatment planning, intervention, monitoring, evaluation, and documentation for identified skilled or custodial level patients. The goal of the Inpatient SNF Case Manager is to effectively manage the patients' SNF stay to ensure the right level of care is provided and that all the patients' medical, environmental, and psychosocial needs are met, both during their stay, immediately upon discharge, and post-discharge.
Key Responsibilities- In collaboration with the VP of Inpatient SNF Case Management and SNF Medical Director, implement all medical management programs and processes that are consistent with the strategic, operational goals of the company.
- Participate in Comprehensive Care rounds as scheduled and interface with SNF Physician team for appropriate utilization/case management in conjunction with the VP Inpatient SNF Case management and SNF Medical Director.
- Demonstrate proficiency in all IS systems to support departmental functions, including REA, Milliman Guidelines, InterQual, and internet.
- Direct oversight of SNF cases in conjunction with SNF Medical Director and VP Inpatient SNF Case Management.
- Responsible for documentation, including but not limited to, initial admission assessment, Interdisciplinary Team meeting(s), concurrent reviews, and discharge summary on all cases assigned.
- Interact with patients and families to keep all parties updated as to discharge plans and needs.
- Responsible for the safe discharge of patients with the necessary resources to ensure that care is provided without interruption as they transition to the next level of care.
- Oversee and monitor the authorization workflow process for SNF Case Management.
- Maintain confidentiality of all patients and medical/clinical information per HIPAA guidelines.
- Reviews the SNF claim data, urgent and emergency room utilization, acute inpatient census, referrals from providers and vendors, and other appropriate data, to initiate a follow-up member assessment.
- Develops individualized treatment plans, as appropriate, incorporating assessment, education, resource planning, and coordination of members' discharge needs, including but not limited to, referrals to ancillary services as identified as appropriate for all patients assigned.
- Training, mentoring, auditing of the clinical competency, productivity, contribution, customer service interaction of Program and Department professional and non-professional staff.
- Performs a liaison function for the member's physician(s) by consistently communicating any modifications to the treatment plan to all participating disciplines and coordinates appropriate information that must be communicated to the patient and family.
- Performs a liaison function for members enrolled in a Disease Management Program, with Health Plan.
- Maintains documentation of individual case management plans, interventions, other statistics as needed, to demonstrate the clinical quality outcomes and cost-effective financial impact of case management.
- Chairs meetings, as appropriate, with the multidisciplinary team, primary care physician, and other participating personnel to update all relevant team members regarding the patient's status and the need for any modifications to the treatment plan, as assigned by Director of Inpatient Case Management.
- Ability to commute to various facilities on any given day within 30 miles of the worksite office.
- Perform on-call duties as applicable as required.
- Provides coverage for colleagues on scheduled/unscheduled PTO as needed as identified.
- All other duties as directed by management.
- Proactively support and practice company mission, vision, and values.
- Follow Employee Handbook guidelines and company policies and procedures.
- Follow established departmental dress code.
- Appropriately and accurately maintain time-keeping records.
- Adhere to attendance policy and time-off requests.
- Follow safety policies and procedures.
- Be flexible and adaptable and courteous and promote professionalism.
- Communicate verbally and in writing through appropriate channels.
- Maintain confidentiality at all times in compliance with company policy and HIPAA requirements.
- Employee has completed all required annual Compliance training and signed attestation form is attached for each module.
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