Director of Nursing - Confidential - Hospital

JOB TITLE: Case Manager
REPORTS TO: Administrator
FLSA STATUS: Non-Exempt

JOB OVERVIEW: In collaboration with the physician provides individual program management for each patient to ensure the patient's progression through the continuum of care in a manner that achieves the desired clinical and financial outcomes. Monitors and manages clinical and financial coordination of treatment plan of assigned patients to ensure timely, cost-effective, individualized service delivery. Works with rehabilitation patients with various disabilities including, but not limited to: spinal cord injury, brain injury, cerebrovascular accident, amputation, neurologic disorders, orthopedic conditions, and arthritis. Coordinates length of stay management within Medicare (CMS) guidelines and 60% compliance threshold.

ESSENTIAL FUNCTIONS INCLUDE BUT ARE NOT LIMITED TO:

a. Meets with patient upon admission to discuss rehabilitation process and role of case manager.

b.Conducts and documents initial patient assessment within 72 hours, to include psychosocial, family and disposition status; determines tentative initial discharge plans in conjunction with patient and family goals.

c. Appropriately modifies approach to the patient based upon patient's age and developmental level.

d. Involves the patient/family in the development of the plan of care by obtaining their goals for rehabilitation.

e. Reviews goals with patient's family (with patient's permission) and third party payer.

f. Maintains accurate up-to-date documentation in the medical records of patient and family contacts, communications with payers and other services performed on behalf of patient and family.

g. Coordinates, evaluates, documents and reviews interdisciplinary team goals as they pertain to the plan of care and discharge plan.h. Coordinates team conferences.

i. Documents in the medical record a summary of the team conference.

j. Serves as the primary family contact (with patient permission) for the treatment team, communicating within 48 hours of the team conference. Also updates the external case manager and/or payer source regarding progress, plan and patient's future needs (as requested by payer source).

k. Ensures the scheduling of family conferences, family participation in therapy and provides pertinent information to appropriate team members.

l. Documents in the medical record a summary of the family conference.

m. Coordinates completion of discharge plans by assisting with arrangements for family education, equipment and services as appropriate for patient discharge level of care.

n. Calls patient or family as needed post-discharge to ensure planned discharge recommendations are occurring and to assess if additional services are needed.

o. In collaboration with the Controller, monitors and ensures needs of per diem negotiations, recertification, concurrent reviews and timely reports.

p. Participates in monitoring, analyzing and utilizing program evaluation data to promote quality of care and position hospital for success.

q. Works closely with finance in order to facilitate Utilization Management program.

r. Maintains good working relationships with other hospital departments, participates in hospital meetings and serves on hospital committee as requested.

Knowledge, Skills and Abilities:

Language Skills: Able to communicate effectively in English, both verbally and in writing.
Skills: Basic computer knowledge
Education and Experience:
Current Louisiana Licensure as an LPN or RN. Fifth year college or university program certificate; or two to four years related experience and/or training; or equivalent combination of education and experience. Knowledge of basic bookkeeping, office procedures, and electronic billing procedures. BCLS - required.

Medical; dental; vision coverage, life, accident insurance, 401K offered,

Paid Time Off/sick and vacation.