Case / Care Manager Job Description
Case / care manager
provides participants with a list of community resources including transportation, medical, educational, financial, legal, religious and other social adjustment or facilitative resources.
Case / Care Manager Duties & Responsibilities
To write an effective case / care manager job description, begin by listing detailed duties, responsibilities and expectations. We have included case / care manager job description templates that you can modify and use.
Sample responsibilities for this position include:
Assist in developing, implementing and monitoring the office-based Chronic Care Program
Assist in designing an operational framework
Work on optimal program participation and prioritization of at-risk patients, and adhere with disease specific treatment guidelines and objectives
Coordinate with the CMO Medical Management Clinical Coordinators and other Clinical Programs
Provide coordination and continuity of care
Assist in evaluating program effectiveness on an ongoing basis
Implements, coordinates and monitors efficient care for targeted patients using a variety of health care delivery systems as appropriate
Researches and selects care options as appropriate
Maintains a comprehensive, computerized medical and social history for assigned patients
Regularly assesses and evaluates the effectiveness and quality of services
Case / Care Manager Qualifications
Qualifications for a job description may include education, certification, and experience.
Licensing or Certifications for Case / Care Manager
List any licenses or certifications required by the position: BLS, CPR, PHN, AHA, CCM, ACM, CWOCN, CWON, HP, CM
Education for Case / Care Manager
Typically a job would require a certain level of education.
Employers hiring for the case / care manager job most commonly would prefer for their future employee to have a relevant degree such as Bachelor's and Master's Degree in Human Services, Education, Social Work, Health, Psychology, Nursing, Management, Leadership, Graduate, Counseling
Skills for Case / Care Manager
Desired skills for case / care manager include:
Community health and social service agencies and additional community resources
Experience with medical coding
HMO UM and QM Processes
Health plan criteria
IPA Operations
Medical Terminology through college level coursework
Medical terminology
Medicare and Medicaid guidelines
Outlook
Word and Excel
Desired experience for case / care manager includes:
Serves as a program advocate by conducting training sessions, offering presentations, visiting providers
Identifies problems, anticipates complications and acts to avoid them
Identifies plateaus, improvements, regressions and depressions
Makes personal visits/contacts the physician to clarify diagnosis, prognosis, therapies, activities of daily living
Provides authorizations for any modalities of treatment recommended
Assists with getting information and forms for living wills, health care proxy, DNR order
Case / Care Manager Examples
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Case / Care Manager Job Description
Job Description Example
Our innovative and growing company is looking for a case / care manager. Please review the list of responsibilities and qualifications. While this is our ideal list, we will consider candidates that do not necessarily have all of the qualifications, but have sufficient experience and talent.
Responsibilities for case / care manager
- Contacts patient within 48 hours of discharge assuring proper support and services are in place to make a full recovery (i.e., equipment, home health, other services, transportation)
- Specific issues may include educating newly diagnosed patients about the disease and treatments
- Working independently to deliver quality healthcare to their patients
- Providing a variety of specialized services, such as Simple to Complex Wound Therapy, Post-Surgical Care Management, and Ostomy Care Management
- Screen patients for Level of Care Inpatient, Observation, Emergency and other outpatient services
- Coordination of Care with Interdisciplinary team
- Resource Management- including capturing Avoidable Days, over utilization of services
- Develop and document Assessment, Patient Progress Note and Transitional Care Plan
- Retrospective reviews when needed for short stay admissions
- Active participation with insurance and physician to avoid denials and/or work to reverse negative denial decisions from payer
Qualifications for case / care manager
- Must have the ability to work in a matrix reporting system
- Must be knowledgeable of nursing and medical practices and procedures, laws, regulations, and guidelines that pertain to managed care and nursing facilities
- Must possess the ability to plan, organize, develop, implement, and interpret the programs, goals, objectives, policies and procedures, , that are necessary for providing quality care
- Must be able to navigate an electronic health record (EHR)
- Bachelor’s degree in a human services field
- Must have two years of full-time, post-bachelor’s degree accumulated MH/DD/SA experience with the population served
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Case / Care Manager Job Description
Job Description Example
Our company is growing rapidly and is looking for a case / care manager. If you are looking for an exciting place to work, please take a look at the list of qualifications below.
Responsibilities for case / care manager
- Communicate with physicians, transferring hospitals, payers, admitting for authorization prior to transfer
- Prepare PRI, departmental forms, ensure education of patient and family with accurate documentation throughout hospital stay and at discharge
- Active participation in performance improvement, department activities and data collection efforts
- Always maintain a high level of customer service
- Ability to coordinate and facilitate resources for patient care
- Ability/Knowledge regarding documents necessary for placement and coordination of services for patients
- Able to handle on-call situations, respond to trauma, outpatient clinic needs
- Active participation in multi-disciplinary care planning team
- Appropriate, timely and comprehensive documentation on the Medical Record and interdisciplinary form
- Assume responsibility for monitoring, obtaining signatures and documenting in Canopy, the Important Message from Medicare
Qualifications for case / care manager
- Document appropriate and required information in Canopy Software according to Department Guidelines
- Review of Medical Record and patient/family interview to gather appropriate information for comprehensive assessment
- Serves as a patient/family advocate
- Works closely with hospital attorney and physicians as required
- Knowledgeable in InterQual
- Minimum two years (2) direct patient care experience
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Case / Care Manager Job Description
Job Description Example
Our growing company is looking to fill the role of case / care manager. If you are looking for an exciting place to work, please take a look at the list of qualifications below.
Responsibilities for case / care manager
- Play a key role in supporting patient programs
- Responsible for proactively managing specific patient populations
- Provide symptom management
- Deliver advanced care planning education
- Provides psychosocial support
- This position will require travel between clinic locations and clinic nursing coverage as needed
- Utilization review and discharge planning for capitated patients who are hospitalized
- Educates students, families and the community, regarding the integrated healthcare services and policies
- Hands off communication
- Manage patient care, to achieve cost-effective utilization of resources through the proactive coordination of services in order to move patients efficiently through the continuum of care
Qualifications for case / care manager
- 3 years of clinical RN experience in the Acute Care Hospital Setting
- Understanding and knowledge of payer eligibility and reimbursement regulations with impact on the continuum of care
- Knowledge and ability to use/refer to community resources for coordination of discharge from acute care and Emergency Department settings
- Ability to mentor and train nursing and clerical staff members
- Master’s Degree in Nursing or Health Care related area
- Current Certified Case Manager (CCM) or Accredited Case Manager (ACM) certification
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Case / Care Manager Job Description
Job Description Example
Our company is looking for a case / care manager. To join our growing team, please review the list of responsibilities and qualifications.
Responsibilities for case / care manager
- Completes a review of the Plan of Treatment (485) and OASIS documentations to ensure quality care
- Works with the Beacon team to ensure completion of all requirements of the program as outlined by DMAS, including meeting face-to-face with members and ICTs as necessary and appropriate
- When assigned, responsible for components of member assessment and/or ICP formulation
- When assigned, acts as the primary point of contact for members upon program enrollment and is responsible for member engagement through the assessment process
- Completes a comprehensive assessment on each assigned member, utilizing an approved assessment tool.The assessment must be completed within specified timeframes and by assigned priority
- Meets with the individual and his/her guardian or care provider, as appropriate, to complete the assessment, which may take more than one call/visit if the individual’s condition is too fragile/unstable to tolerate a full assessment in one sitting (whenever possible the assistance of a caregiver or family individual will be elicited to complete the assessment in one appointment)
- Communicates with members about their ongoing or newly identified needs at a regular frequency, as defined by policy (at minimum monthly), to include a face-to-face meeting
- Develops and maintains the Plan of Care and makes information related to the Plan accessible to providers and Members as needed and upon request
- Soliciting and complying with the member’s wishes (e.g., advance directive about wishes for future treatment and health care decisions, prioritization of needs and implementation of strategies)
- May require some out-side business hours on call rotation
Qualifications for case / care manager
- At least three years related acute hospital patient care experience is preferred
- A minimum of 1-2 years of pediatric nursing experience
- Exceptions will be considered on a case-by-case basis at each facility by the Director of Care Management in consultation with the Human Resources leader
- RNs employed prior to 4/1/17 are encouraged to obtain a Bachelor's degree or higher degree in Nursing, but obtaining the degre will not be a condition of employment
- Current Basic Life Support Card (BLS) for Healthcare Providers sponsored by the American Heart Association
- Minimum of one year experience within the past three years in an acute hospital setting as Registered Nurse
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Case / Care Manager Job Description
Job Description Example
Our company is growing rapidly and is looking to fill the role of case / care manager. We appreciate you taking the time to review the list of qualifications and to apply for the position. If you don’t fill all of the qualifications, you may still be considered depending on your level of experience.
Responsibilities for case / care manager
- Manage caseload in the program to include home visits, telephone contact and written communication with clients on a monthly basis
- Maintain client records per policies, regulatory, etc requirements
- Perform chart reviews as required
- Communicate continually with patients and families, physicians, care team members, and third-party players to facilitate coordination of clinical activities and to enhance the effect of a seamless transition from one level of care to another across the continuum, including facilitating and participating in patient care conferences
- Procure services and resources for identified patients and families, serving as an advocate to promote achievement of agreed-upon goals
- Serve as a resource and provides education to patients, physicians, and professional staff on levels of care, quality-of-care issues, and regulatory concerns
- Orient and educate clients and sometimes their families by meeting them
- Perform and review client intake assessment and use results to coordinate the completion of the care plan, self-management goals and strategies
- Interview clients to assess client needs, prioritize needs, identify barriers in addressing needs, and strategize to overcome barriers
- Develop interdisciplinary care plan and other case management tools by participating in meetings
Qualifications for case / care manager
- Bachelor's Degree in Nursing (BSN) strongly preferred
- Minimum of 3 years experience in case management, discharge planning, and/or utilization review
- Bachelors Degree in Social Work from a college or university accredited by the council on Social Work Education required
- MSW preferred
- Will consider a Masters Degree in Social Work in lieu of a BSW
- Minimum of three years in inpatient or outpatient setting required