Summary & Objective
The Director, Case Management oversees staff of case managers and develops and implements case management programs, including utilization review, discharge planning, and managed care contracting or negotiation. Evaluates patient care data to ensure that care is provided in accordance with clinical guidelines and organizational standards.
- Interviews resident and/or patient and completes assessment within 48 working hours, and documents in Medical Record.
- Obtains timely insurance re-certifications and provides weekly updates verbal/written for continued stay authorization and enters into billing software.
- Attends interdisciplinary team conference to discuss resident and/or patient status.
- Conducts family conference meetings as needed.
- Discharge planning to the community with but not limited to home health, durable medical equipment, outpatient services referrals, Long Term Care, Assisted Living Facility and Skilled Nursing Facility.
- Educates patient and/or family of advanced directives.
- Educates community resources and programs to patient and/or family.
- Coordinates and obtains authorization from insurance company for all procedures, appointments and transportation for all HMO residents and/or patients.
- Communicates responsible party when person served is approaching the end of rehabilitative care status and interprets recommendations for continuation of care.
- Provides Important Medicare Letter of Rights to resident and/or patient and/or family and obtains signature on form as warranted within 24 hours prior to discharge.
- Follows Medicare appeal process as needed.
- Completes and posts discharge notification forms prior to discharge to interdisciplinary team.
- Documents resident and/or patient progress notes on a weekly basis or as needed in the Medical Record.
- Manages resident and/or patient's length of stay according to their medical needs.
- Serves as a liaison with physician and continuously communicates regarding resident and/or patient's status and/or concerns.
- Participates in daily, weekly or monthly management team meetings to discuss patient and/or resident's status, census changes, personnel, or patient and/or resident's complaints or concerns to ensure an effective Quality Assurance Performance Improvement (QAPI) program.
*Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of the position.
- Acts as a designee in the absence of the Grievance Coordinator if applicable.
- Contacts appropriate state agency when unsafe discharge, neglect and/or abuse is suspected in collaboration with Risk Manager and interdisciplinary team if applicable.
- Ensures Case Management Department is prepared for inspections/surveys.
- Promotes customer service and hospitality and responds to and adequately resolves complaints or concerns
from patient and/or resident's or families.
- Completes employee evaluations on a timely basis. Accurately and objectively assesses performance.
- Promotes positive employee engagement, teamwork, and mutual respect and safety work practices.
- Maintain mandatory skill updates
- Comply with all policies, local, state and federal laws and regulations
- Perform other duties as assigned
- May serve as an interim department leader depending on need.
- Must be able to lift and/or move up to 50 pounds and push/pull up to 250+ pounds, walk, climb stair or ladders, stand on feet for extended periods of time, etc.
The job description is not designed to cover or contain a comprehensive listing of activities duties or responsibilities that are required of the employee. Other duties, responsibilities and activities may change or be assigned at any time.
CHS provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.
This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.
Knowledge & Experience Requirements
- Clear and Active Registered Nurse or Licensed Practical Nurse license to practice in the state of Florida, Social Work or related clinical field
- CPR certification
- 5+ years of experience in a Health Care Facility
- Must have knowledge of computer office/clinical software
- Must be able to read, write and understand the English language.