Lead Case Manager

$50.83 - $64.46

We would expect those hired into this job would be paid within this pay range, however, certain circumstances may allow us to pay outside of this range.

Job Summary

Provides leadership for the case management team and assists with the daily operational oversight of the Case Management and Utilization Management activities in a Kindred hospital. Coordinates and facilitates the care of the patient population through effective collaboration and communication with the Interdisciplinary Care Transitions (ICT) members. Serves as a subject matter expert, mentor and preceptor to staff, performing staff education related to resource utilization, discharge planning and psychosocial aspects of healthcare delivery. Follows patients throughout the continuum of care and ensures optimum utilization of resources, service delivery and compliance with external review agencies. Provides ongoing support and expertise through comprehensive assessment, care planning, plan implementation and overall evaluation of individual patient needs. Enhances the quality of patient management and satisfaction to promote continuity of care and cost effectiveness through the integration of functions of case management, utilization review and management and discharge planning. Partners with external customers, referral sources and payors to ensure the facilitation and coordination of the discharge planning process and serves as the patient and family advocate. Accountable for the facility’s denial management program.

Essential Functions 

Care Coordination

• Serves as a subject matter expert in the daily coordination of patient care to facilitate development, monitoring, and refinement of treatment plan.
• Works with the Director of Case Management to ensure areas of responsibility are operating in compliance with CMS, State and JCAHO regulations and standards and with Kindred policies, including documentation and record requirements.  Actively participates in surveys and audits.
• Coordinates clinical and/or psychosocial activities with the Interdisciplinary Team and Physicians. 
• Monitors all areas of patients’ stay for effective care coordination and efficient care facilitation. 
• Remains current from a knowledge base perspective regarding reimbursement modalities, community resources, case management, psychosocial and legal issues that affect patients and providers of care. 
• Appropriately refers high risk patients who would benefit from additional support.  
• Serves as a patient advocate.  Enhances a collaborative relationship to maximize the patient’s and family’s ability to make informed decisions. 
• Demonstrates knowledge of the principles of growth and development over the life span and the skills necessary to provide age-appropriate care to the patient population served.
• Participates in interdisciplinary patient care rounds and/or conferences to review treatment goals, optimize resource utilization, provide family education and identified post hospital needs. Collaborates with clinical staff in the development and execution of the plan of care, and achievement of goals. 
• Coordinates with interdisciplinary care team, physicians, patients, families, post-acute providers, payors, and others in the planning of the patients’ care throughout the care continuum.

Discharge Planning

• Conducts comprehensive, ongoing assessment of patients to provide timely and safe discharge planning. 
• Provide comprehensive discharge planning for each patient. Utilizes critical thinking to develop and execute effective discharge planning. 
• Coordinate and communicates with patient/family efficiently and effectively. 

Utilization Management 

• Conducts medical necessity review for appropriate utilization of services from admission through discharge. 
• Promotes effective and efficient utilization of clinical resources.
• Conducts timely and accurate clinical reviews, care collaboration and coordination of continued stay authorization with payor.  

Other

• Conducts job responsibilities in accordance with the standards set out in the Company’s Code of Business Conduct, its policies and procedures, the Corporate Compliance Agreement, applicable federal and state laws, and applicable professional standards.
• Serves on Hospital and Division committees when requested.

Knowledge/Skills/Abilities/Expectations

• Knowledge of government and non-government payor practices, regulations, standards and reimbursement.
• Knowledge of Medicare benefits and insurance processes and contracts.
• Knowledge of accreditation standards and compliance requirements.
• Knowledgeable and adaptable to various learning styles.
• Ability to demonstrate critical thinking, appropriate prioritization and time management skills.
• Must read, write and speak fluent English.
• Basic computer skills with working knowledge of Microsoft Office, word-processing and spreadsheet software.
• Excellent interpersonal, verbal and written skills in order to communicate effectively and to obtain cooperation/collaboration from hospital leadership, as well as physicians, payors and other external customers.
• Demonstrates good interpersonal skills when working or interacting with patients, their families and other staff members.
• Must have regular attendance.
• Approximate percent of time required to travel, 0%.
• Performs other related duties as assigned.

Education

• Graduate of an accredited program required; BSN preferred
• Master of Social Work with licensure as required by state regulations
• Bachelor of Social Work with licensure as required by state regulations.

Licenses/Certification

• Healthcare professional licensure required as Registered Nurse, or Licensed Clinical Social Worker (LCSW) or Licensed Social Worker (LSW) if required by state regulations. 
• Certification in Case Management preferred.

Experience

• Two years of experience in a healthcare setting preferred, preferably, acute or LTACH.
• Prefer prior experience in Case Management, Utilization Review, or Discharge planning.