Case Manager (Bilingual)

Catholic Health Services•Lauderdale Lakes, FL

About The Position

The Case Manager coordinates discharge planning for residents and/or patients and helps manage their healthcare and social service needs by serving as a liaison between them and physicians and nurses regarding their progress and status in the facility. The role also helps residents and/or patients access community resources and programs. The Case Manager assesses residents and/or patients, supports insurance authorization and continued-stay processes, participates in interdisciplinary and management meetings, coordinates discharge services, and communicates with patients, families, responsible parties, physicians, insurers, and third-party programs. The position may serve as an interim department leader depending on need. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of the position.

Requirements

Clear and active Registered Nurse or Licensed Practical Nurse license to practice in Florida, or a background in Social Work or a related clinical field.
CPR certification.
1–3 years of experience in a health care facility.
Knowledge of computer office and clinical software.
Ability to read, write, and understand English.
Ability to lift and/or move up to 50 pounds and push/pull up to 250+ pounds.
Ability to walk, climb stairs or ladders, and stand for extended periods.

Responsibilities

Interview residents and/or patients, complete assessments within 72 working hours, and document them in the Medical Record.
Obtain timely insurance re-certifications, provide weekly verbal or written updates for continued-stay authorization, and enter information into billing software.
Attend interdisciplinary team conferences to discuss resident and/or patient status.
Conduct family conference meetings as needed.
Plan discharges to the community, including referrals for home health, durable medical equipment, outpatient services, Long Term Care, Assisted Living Facilities, and Skilled Nursing Facilities.
Educate patients and/or families about advance directives when applicable and about community resources and programs.
Coordinate and obtain insurance authorization for procedures, appointments, and transportation for HMO residents and/or patients.
Communicate with patients and/or responsible parties when rehabilitative care is nearing its end and explain recommendations for continued care.
Provide the Important Medicare Letter of Rights and obtain a signature when warranted within 24 hours before discharge.
Provide the Notice of Medicare Non-Coverage and obtain a signature 48 hours before discharge when applicable.
Follow the Medicare appeal process and maintain a log as needed.
Complete and post discharge notification forms to the interdisciplinary team before discharge.
Document resident and/or patient progress notes weekly or as needed in the Medical Record.
Serve as a liaison with physicians and continuously communicate about resident and/or patient status and concerns.
Participate in daily management team meetings concerning status, census changes, and complaints or concerns.
Conduct follow-up phone calls 48 hours after discharge.
Obtain HMO level increases for items such as IVs, high-cost drugs, special equipment, and changes in skilled needs when applicable.
Communicate and coordinate with third-party bundled payment programs when applicable.
Conduct 30-day follow-up phone calls to monitor returns to acute care.
Promote customer service and hospitality, resolve complaints or concerns from patients, residents, or families, and inform the Director, Case Management/Social Services.
Provide orientation to new employees as needed.
Maintain required licenses, certifications, and mandatory skill updates.
Comply with policies and applicable local, state, and federal laws and regulations.
Perform other duties as assigned.