Job Responsibilities

• Daily review of Hospital and Skill Nursing Home inpatient list
• Case Review forms to UM / Quality Department by 4:00 PM New admissions
• Daily updates from Hospital and/or SNH Case Managers
• To provide information to Hospital and/or SNH Case Manager
• To coordinate post in patient admission services and office follow up
• To obtain medical records from Hospital and/or SNH for office follow up
• Family dynamics and support systems
• Coordinate with PCP and Care Team at Facilities any possible admissions and/or ER diversions to a Skilled Nursing Home
• Notify Skilled Nursing Home admitting physician and Case Manager of any possible admissions and provide medical information as needed
• Maintain appropriate documentation in available systems EMR and any other CM software
• Contact high risk patients when they are no shows.
• Document in the chart the reason and reschedule
• Regular interaction with office Care Team to review elective/future inpatient and outpatient procedures.
• Review w/ PCP
• Review Pre-op clearance w/ office staff
• Notify UM/Quality Department Director of upcoming inpatient procedures
• Review all out of the area admissions and keep a daily report
• Notify Medical Economics/ Data Department of all out of area admissions
• Daily review of office schedules to identify any patients that need Case Management intervention.
• Recent Hospital/SNH discharges
• Disease Management
• Education on Advanced Directives, Community Services information
• Case Management System
• Maintain most current patients’ information
• Tracking system for Hospital/SNH admissions and Disease management
• To identify patients for Disease Management and follow up according to protocol
• CAD/CHF/COPD/DM/CKD Disease Management
• New patient orientation: All HMO Managed Care Advantage new members orientation within the 1st month of enrollment
• Completion of: Mini Mental, ADLs screening, psychosocial assessment (See new patient orientation form)
• Identification of any transfer for cause members or reallocation cases
• To maintain monthly logs

Job Qualifications

• Current Registered Nurse
• Case Manager will work towards and maintain Case Management Certification
• Case Manager will maintain continuing education appropriate for case management and professional licensure
• CPR/BLS certification

BENEFITS

• Comprehensive benefits package, including Health, Vision, Dental, and Life insurances
  • FSA and Life Assistance Program (EAP)
  • 401(k) Retirement Plan
  • Health Advocacy, Travel Assistance, and My Secure Advantage
• PTO Accrual and Holidays

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