Case Manager - Post Acute Brain Injury Day Program

The Case Manager works within an interdisciplinary team to facilitate the patient plan of care throughout the continuum of care by ensuring appropriate utilization management, care coordination, resource utilization, and clinical documentation. The Case Manager functions include accountability for assessing, planning, implementing, evaluating, and communicating the patient care plan progression. The Case Manager utilizes the principles of mutual respect, patient/family advocacy and provides leadership within the team of internal partners and outside agencies to facilitate best practices that achieve quality clinical, financial, and patient satisfaction outcomes.

Job Responsibilities:

• Supports advocacy for patients and their families by promoting high standards of patient care, participating in program evaluation and development and other designated department related tasks.

• Works closely with clinic physicians to address patient issues (therapy goals, vocational interests/goals, and patient financial status) as they arise in clinic setting.

• Works with patient and family to develop a mutually acceptable plan of care to maximize the potential of the patient, family, and community.

• Bridges communication between providers, patients and families, members of the interdisciplinary team, and outside agencies to assure high-quality care that meets the patient’s needs and is delivered in a cost-effective and timely manner.

• Coordinates physician orders to outside suppliers, including home health, durable medical equipment, and supplies.

• Collaborates with inter and intra-departmental supervisory staff to ensure quality patient care and functions within the scope of Shepherd Center's philosophy, policies and procedures.

• Promotes and facilitates a multidisciplinary approach to coordinate care and plan operations among disciplines.

• Acts as resource for case manager associates and practitioners and assists with problem solving and difficult cases. Serves as a resource person of expertise within department, Shepherd Center, and the community.

• Manages requests for medication assistance, forms, and letters that come to the outpatient case management office.

• Provides the team with active support by meeting with patient's, families, and vendors to create the best outcomes for our patient treatment plans.

• Provides direct assistance with customer service issues to work to create a win-win for all parties involved.

• Completes regular rounding opportunities and assists with yearly evaluations on case management associates.

• Provide education, guidance, and support post discharge, with a strong focus on medical, financial and psychosocial needs.

• Completes thorough and accurate documentation in electronic records.

• Coordinates language services when interpretation needs arise in the clinic.

• Maintains appropriate certification.

• Understand ethical considerations, patient in crisis in relations to finances, neglect, abuse, psychosocial needs, etc.

• Maintains knowledge of current relevant state and federal regulations, Joint Commission standards and criteria, and documentation requirements.

• Practices proper safety techniques in accordance with Center and departmental policies and procedures. Responsible for the reporting of employee/patient/visitor injuries or accidents, or other safety issues to the supervisor and in the occurrence notification system.  
• Monitors and ensures compliance with all regulatory requirements, organizational standards, and policies and procedures related to area of responsibility. Identifies potential risk areas within area of responsibility and supports problem resolution process.
• Performs other duties as assigned.

Minimum Required Education:

• Associate or Bachelor’s degree (allied health, nursing, or related field) or appropriate state licensure.

Required Minimum Certification:

• Certification in Case Management (Case Management Society of America, American Case Management Association, American Nurses Credentialing Center, or equivalent certification within two years of position start date. Individuals hired prior to October 1, 2022 are grandfathered in and must obtain their CCM or ACM within two years from October 1, 2022.  

Required Minimum Experience:

• Minimum of two (2) years broad clinical experience. Experience in care coordination, case management, discharge planning and utilization review preferred.

Required Minimum Skills:

• Effective time management skills.  

• Excellent communication skills, both verbal and written.

• Effective decision making/problem-solving skills and creativity in problem solving.

• Demonstrated effective critical thinking skills and ability to anticipate patient discharge needs.

• Understanding of the interdisciplinary team approach and rehabilitation environment.

• Moderate to expert computer skills.

• Working knowledge of financial aspects of third-party payors and reimbursement

Preferred Qualifications:

• N/A

Physical Demands:

• Sedentary work involves sitting most of the time but may involve walking or standing for brief periods of time or exerting up to 15 pounds of force occasionally or a negligible amount of force frequently to lift, carry, push, pull, or otherwise move objects, including the human body.

Working Conditions:

• Some potential for exposure to blood and body fluids.

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The above statements are intended to describe the general nature and level of work performed by people assigned to this classification.  They are not intended to be an exhaustive list of all job duties performed by the personnel so classified.