• The Case Manager serves as a patient advocate and is responsible for the collaborative process of patient assessment, the planning and the facilitation of care, the advocacy for options and services to meet the individual’s health care needs through communication and the utilization of community continuum of care resources to promote quality cost effective outcomes.
• Utilizes all elements of Case Management Society of America’s (CMSA) role functions, which include, but may not be limited to: Assessment, Planning, Facilitation, and Advocacy
• Completes case management assessment, within a designated time period. Reviews admitting clinical information and psychosocial information and determines a plan to address the client’s needs and preferred discharge plan early on from the beginning of the admission.
• Collaborates with physicians, nursing and support staff, patients and families to arrange prompt and safe discharge plans at an expected time of departure.
• Acts as a consultant to all disciplines specific to Case Management programs and functions as a resource to patient/family/other providers for continuum of care, payer and regulatory issues.
• Completes case management assessment, within a designated time period. Reviews admitting clinical information and psychosocial information and determines a plan to address the client’s needs, and preferred discharge plan.
• Directs, coordinates and provides Case Management to patients on caseload, based on assessment and or referral. Collaborates in the development and implementation of the Case Management process.
• Monitors the cost effectiveness of the plan, delay days and utilization. Responsible to communicate all delays, over utilization and concerns to the attending physician, department manager, and/or the physician advisor.
• Interacts with patient and others in a courteous and respectful manner, inspiring confidence by performing and communicating in a professional and ethical manner.
• Conducts necessary conferences and team meetings regarding specific patient needs.
• Documents at a minimum of every 2 days or as the discharge plan changes or progresses.
• Maintains current knowledge of Case Management, Utilization Management, Discharge planning and resources available as specified by the Federal, States and private insurance guidelines and regulations.
• Issues the appropriate letter of non-coverage, explains the process for appeal, facilitates requested appeals and explains any financial liability. Accurately document transactions in the medical record.
• Participates in the denial/appeals management including tracking and collection of data.
• Upholds requirements of continued education as required by the hospital and the department
- At least 2 years of experience in an acute care setting
- Preferred 2 years of experience in case management and utilization review in an acute hospital setting.
- Working knowledge of healthcare finances, regulatory agencies and Interqual guidelines preferred. Microsoft word, Power point, excel. Ability to learn an electronic medical record documentation system.
- Bachelors of Science in Nursing OR
- Masters in Social Work with ability to be licensed in Delaware.
- Willing and able to obtain Acute Case Management Certification
801 Middleford Rd,Seaford, DE
Monday - Friday - Some Weekends and Holidays
8:00am - 4:30pm