License and Certification:
• Must be qualified to independently complete an assessment within the scope of practice of his/her discipline (for example, RN, SW, OT, PT, ST, and Rehabilitation Counseling).
• If licensure is required for his/her discipline within his/her state, individual must hold an active license.
• Current CCM® or ACM™ certification is required or must be obtained within one year of being placed in the position.
Education, Training and Years of Experience:
• For Nursing, must possess baccalaureate degree in Nursing (BSN) with RN licensure.
• For other eligible health care professionals, must possess a minimum of a baccalaureate degree and graduate degree is preferred.
• 3 years of hospital based Case Management experience including Utilization Review and Discharge Planning experience.
Essential Job Functions:
• Performs all duties and responsibilities as described in Case Manager job description when providing case management services.
• Manages caseload assignment of patients to case managers.
• Oversees team conference process and educates staff in facilitation and reporting.
• Leads daily case management operations meetings, represents department in hospital operations.
• Analyzes reports from PATCOM, UDS, and Press Ganey.
• Implements and educates case managers on effective utilization of the continuum of care and community resources.
• Completes special projects and other duties as requested to support needs of organization.
• Coordinates and supports hospital utilization review process.
• Ensures compliance with CMS regulations and Conditions of Participations for discharge planning.
• Assigns patient caseload to dept members and self for optimal service delivery.
• Manages core staffing plan and employs flexible staffing plan as necessary.
• Acts as a resource for case managers and other team members.
• Coordinates with other department managers to direct quality of care delivery.
• Participates in administrative on-call schedule and coordinates case management on-call schedule.
• Reports questionable situations, concerns, complaints or harassment immediately.
• Completes mandatory training and courses required by completion date.