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Case Manager II

Location: Braintree, Massachusetts

Date Posted: 07 Jun, 2022

• Works with interdisciplinary team, guiding treatment plans based on patient needs and preferences.
Facilitates the development of a safe and effective plan of care through early identification and thorough assessment of the patient’s needs and resources available.
Promotes effective interdisciplinary team dynamics, communication and facilitates a positive working environment to achieve desired outcomes.
Reviews therapy intensity report daily to identify patient non-compliance trends.
• Coordinates with interdisciplinary team to establish tentative discharge plan and contingency plans.
Incorporates information from initial interview and consultation with team and patient/family.
Establishes contingency discharge plans for high risk cases.
Actively identifies barriers to discharge plan and communicates with patient/family and team to decrease or eliminate such barriers.
 Accurately updates and maintains discharge calendar.
• Participates in planning for, and ensures successful execution of, patient discharge experience.
Confirms final discharge plans after consultation with team and patient.
Prepares and reviews case management discharge paperwork and reviews with patient/representative at least 24 hours prior to discharge.
• Monitors patient experience: quality/timeliness/service appropriateness/payors/expectations.
Promotes informed decision-making through explanation of choices, risks, and benefits to the patient/family member and interdisciplinary team.
• Facilitates team conferences weekly and coordinates all treatment plan modifications.
Identifies potential complications relative to patient care and discharge plan after initial and ongoing team conferences.
• Completes case management addendums and all required documentation.
Manages documentation such as, but not limited to, contact notes, Interdisciplinary Plan of Care (IPOC), team conference form, family conference, continues stay reviews and discharge instructions.
• Maintains knowledge of regulation/standards, company policies/procedures, and department operations.
Maintains knowledge regarding state laws regarding competency and guardianship.
 Demonstrates understanding of the hospital’s patient outcomes and financial goals and the department’s impact on goal achievement.
Incorporates knowledge of independence scoring process to evaluate accuracy of scores throughout length of stay.
Uses RAND methodology to establish Length of Stay management to promote the effective utilization of hospital days or services, and will conduct timely reviews as needed. Notifies supervisor, business office, and patient of any coverage issues as they arise.
Identifies the estimated LOS through RAND reports and will communicate this time frame to patient/family and interdisciplinary team.
• Reviews/analyzes case management reports including Key Care Indicators; plans appropriate actions.
Keeps supervisor informed of reports, Key Care Indicators, and plan adjustments.
• Understands commercial contract levels, exclusions, payor requirements, and recertification needs.
Obtains precertification/authorization from third party payors for noncontractual services, including but not limited to radiology, day hospital services, hematology testing, transportation, outside tests, orthotics/prosthetics.
Demonstrates working knowledge of reimbursement parameters of payors, and effectively educates patients, family and staff on payor issues.
• Completes daily rounds to visit with each patient (family member when applicable).
Monitors current status, communicates new information, and evaluates patient/family satisfaction; completes documentation as needed.
• Attends Acute Care Transfer (ACT) meetings to identify trends and collaboratively reduce ACTs.
• Meets with patient/family per Patient Arrival and Initial Visit Standard within 24 hrs of admission.
• Performs assessment of goals and completes case management addendum within 48 hours of admission.
• Educates patient/family on rehabilitation and Case Manager role; establishes communication plan.
Validates patient/family understanding of information.
Provides education that enhances patient/family member knowledge and a motivation to participate in patient care.
• Schedules and facilitates family conferences as needed.
• Assists patient with timely procuring/planning of resources to avoid discharge delays or issues.
Understands and assists with applications for Medicaid, SSI, Disability, etc.
• Monitors compliance with regulations for orthotics and prosthetics ordering and payment.
Determines funding sources for post discharge needs.
Facilitates referrals to Outpatient care teams or Home Health Services for continued or additional services as needed.
Provides patients/family with Choice Letters regarding available options for post discharge care providers.
• Makes appropriate/timely referrals, including documentation to post discharge providers/physicians.
• Ensures accuracy of discharge and payor-related information in the patient record.
Delivers Important Message from Medicare discharge notification within 2 days of discharge.
Documents orthotics and prosthetics ordering and payment in PATCOM for Medicare primary patients/auto pay.
• Participates in utilization review process: data collection, trend review, and resolution actions.
• Participates in case management on-call schedule as needed.
• Reports questionable situations, concerns, complaints or harassment immediately.
• Organizes, plans, and manages time effectively to complete assignments.
• Completes mandatory training and courses required by completion date.