Summary:
The Large Case Manager shall use a holistic approach to providing large case management services for the client. The Large Case Manager must be clinically sound in all areas of medicine including preventative care, wellness education, acute care, chronic care, rehabilitation, home care and extended care.
The Large Case Manager shall be able to perform the six (6) essential activities of case management, and provide direct client contact in these activities in each of the five (5) care components.
The Large Case Manager shall interact with the patient in an advocacy role. This Large Case Manager also is directly involved with physicians, family members, third party payors, employers, reinsurers, and other social, psychological, and medical health care providers.
Reports To:
Director of Large Case Management
Qualifications:
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Education, Licensure and Experience:
Current Indiana nursing license in good standing. Additional state licensure may be required in regional offices.
Must have:
a) A bachelors degree (or higher) in a health-related field and hold a license as a health professional; and Case Manager Certification; or
b) RN licensure and three (3) years clinical practice experience; and practice case management within the scope of their licensure (within state laws and professional standards regarding assessments) and Case Manager Certification.
Language Skills: Ability to read and interpret documents such as reference books and patient medical records. Ability to compose clinical correspondence. Ability to speak effectively with employees, clients, patients and health care providers.
Mathematical Skills: Ability to add, subtract, multiply and divide in all units of measure, using whole numbers, common fractions, and decimals. Ability to compute rate, ratio, and percent and to interpret simple graphs.
Reasoning Ability: Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form. Ability to apply clinical knowledge to make determinations of medical necessity as outlined by criteria standards. Ability to troubleshoot complex clinical problems and practice independently without supervision of another licensed professional.
Physical Demands: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is regularly required to walk, sit, stand, talk and hear. The employee is frequently required to use hands and fingers to feel and to reach with hand and arms. The employee is required to spend extended periods of time at a computer in which hands and fingers will be used for computer entry. The employee must occasionally lift and or move up to 10 pounds. The employee must also have a valid driver's license and be able to drive for employer onsite visits and hospital record review.
Computer Experience: Must have prior computer experience and be able to navigate the keyboard well. Knowledge of Window-based systems important to this position.
Essential Duties and Responsibilities:
1. The Large Case Manager must perform the six (6) essential activities of case management.
Assessment - Evaluate the patient's social, psychological and physical needs to facilitate the return of the patient to optimal health within individual restrictions of their illness. The Large Case Manager must be capable of using subjective and objective skills including all available sources, such as the patient, family members, professional providers, non-professional providers, employers, medical records, etc.
Planning - The Large Case Manager shall develop an individual care plan for the client. The care plan must address the needs identified in the assessment, taking into consideration all available resources, private and community related; selecting the most qualified cost effective provider that meets all the patient needs.
Implementation - Execute the care plan while maintaining watchful direction of all processes and seeing that continuity of care is achieved - providing for the overall well being of the patient as a whole.
Coordination - Insure an efficient process of organizing, securing, integrating, reviewing, and modifying, if necessary, the resources and services necessary to accomplish the plan objective.
Monitoring - The Large Case Manager will maintain and document the overview of the health care plan process. The Large Case Manager will be adept at modifying the care as the patient's needs change, providing for safe transition to patient autonomy insuring quality while accomplishing the care plan objectives.
Evaluation - The Large Case Manager will evaluate all aspects of the plan to identify plan modifications or anticipate any future needs. The Large Case Manager will gather appropriate data to report patient outcomes.
2. The Large Case Manager will apply the six (6) essential activities within each of the following five (5) core components.
- Coordinated Service Delivery
- Physical and Psychological
- Case Management Concept
- Community Resources
- Benefit Systems and Cost Benefit Analysis
3. Application of all core components across the complete continuum of care.
4. Application of all core components in multiple environments from hospitals, patient homes, rehabilitation, and extended care.
5. Interacts with all facets of the patients' health care system participating in patient care conference and discharge planning.
6. Directs a broad spectrum of health care providers, services, and durable medical needs without direct patient care.
7. Maintains accurate and timely medical documentation and provide accurate reporting information for their clients.
8. Researches and suggests educational offerings to continue the professional, high quality of the practice of case management.
9. Interacts consistently with reinsurance carriers on a daily basis.
10. Tracks individual case management time on billing forms to include hours, phone calls, mileage, etc.
11. Prepares monthly report on all large case management.
12. Communicates daily regarding large cases to the appropriate individuals.
13. Serves on corporate committees as requested.
14. Participates in quality improvement program as designed by ICM.
15. Shall participate in all educational programs in accordance with corporate policy.
16. All other duties as essential to the position.
Special Notes:
1. As defined in all corporate policies and procedures referring to confidentiality, all employees of Individualized Care Management, Inc. are responsible for maintaining the confidentiality of all patient-specific and provider-specific information.
2. This position may be filled with a part-time employee at the discretion of the Company. The Company reserves the right to change this status at any time deemed necessary.
3. This is an exempt position. You are paid on a semi-monthly basis, based upon your base annual salary. Any time worked outside of your normal working hours is not compensable.
