Case Manager

Encompass Health • Albuquerque, NM

7d

About The Position

The Case Manager at Encompass Health coordinates patient care and resources from admission through post-discharge, serving as a link between clinical care and patient outcomes. The role works with interdisciplinary teams to guide treatment plans according to patient needs and preferences, coordinate discharge planning, monitor the patient experience, and oversee care-plan decisions and modifications. The Case Manager also supports patients and families through education, communication, referrals, and resource planning, while ensuring accurate documentation and compliance with applicable regulations, company policies, and payer requirements.

The position includes participating in utilization review, reviewing case-management reports and trends, attending Acute Care Transfer meetings, and taking part in the case-management on-call schedule as needed. Candidates must be qualified to independently complete assessments within the scope of their discipline and hold an active state license when required. CCM® or ACM™ certification eligibility is required upon entry or within two years; certification must be obtained within two years of placement in the Case Manager II position.

Requirements

• Must be qualified to independently complete an assessment within the scope of practice of the individual's discipline, such as nursing, social work, occupational therapy, physical therapy, speech therapy, or rehabilitation counseling.
• Must hold an active license if licensure is required for the individual's discipline in the state.
• Must meet eligibility requirements for CCM® or ACM™ certification upon entry into the position or within two years of entry.
• CCM® or ACM™ certification is required, or must be obtained within two years of placement in the Case Manager II position.
• For nursing candidates, a minimum Associate Degree in Nursing and RN licensure are required; a BSN is preferred. A diploma is acceptable only in states where it meets the minimum requirement for licensure or certification.
• Other eligible licensed or certified healthcare professionals must have at least a bachelor's degree; a graduate degree is preferred.

Nice To Haves

• Two years of rehabilitation experience preferred.
• BSN preferred for nursing candidates.
• Graduate degree preferred for other eligible licensed or certified healthcare professionals.

Responsibilities

• Work with the interdisciplinary team to guide treatment plans based on patient needs and preferences.
• Coordinate with the interdisciplinary team to establish tentative discharge and contingency plans.
• Participate in planning and carrying out the patient discharge experience.
• Monitor patient experience, including quality, timeliness, service appropriateness, payors, and expectations.
• Facilitate weekly team conferences and coordinate treatment-plan modifications.
• Complete case-management addendums and required documentation.
• Maintain knowledge of regulations and standards, company policies and procedures, and department operations.
• Review and analyze case-management reports, including Key Care Indicators, and plan appropriate actions.
• Understand commercial contract levels, exclusions, payer requirements, and recertification needs.
• Attend Acute Care Transfer meetings to identify trends and collaboratively reduce transfers.
• Meet with the patient and family within 24 hours of admission in accordance with the Patient Arrival and Initial Visit Standard.
• Assess goals and complete the case-management addendum within 48 hours of admission.
• Educate patients and families about rehabilitation and the Case Manager role, and establish a communication plan.
• Schedule and facilitate family conferences as needed.
• Help patients procure and plan resources in a timely way to prevent discharge delays or issues.
• Monitor compliance with regulations for ordering and payment of orthotics and prosthetics.
• Make appropriate and timely referrals, including documentation, to post-discharge providers and physicians.
• Ensure discharge and payer-related information in the patient record is accurate.
• Participate in utilization review, including data collection, trend review, and resolution actions.
• Participate in the case-management on-call schedule as needed.

Benefits

• Affordable medical, dental, and vision plans for full-time and part-time employees and their families.
• Paid time off that accrues over time.
• Tuition reimbursement and continuous education opportunities.
• Company-matching 401(k).
• Employee stock purchase plan.
• Flexible spending and health savings accounts.

What This Job Offers

• Job Type: Full-time
• Education Level: Associate degree