Case Manager

Encompass Health • Murrieta, CA

6d

About The Position

The Case Manager coordinates patient care from admission through post-discharge and manages resources while overseeing interdisciplinary plan-of-care decisions. The role guides treatment planning according to patient needs and preferences, supports discharge planning and execution, monitors the patient experience, and ensures accurate documentation and payor-related information. The Case Manager also works with patients and families to explain rehabilitation and the Case Manager’s role, establish communication plans, and arrange needed conferences and referrals. The position participates in utilization review, team conferences, and an on-call schedule as needed.

Requirements

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

Nice To Haves

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

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 executing 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, 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, payor requirements, and recertification needs.
• Attend Acute Care Transfer meetings to identify trends and collaboratively reduce transfers.
• Meet with patients and families within 24 hours of admission in accordance with the Patient Arrival and Initial Visit Standard.
• Assess goals and complete a 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 manner to avoid discharge delays or issues.
• Monitor compliance with regulations for ordering and payment of orthotics and prosthetics.
• Make timely and appropriate referrals, with documentation, to post-discharge providers and physicians.
• Ensure accurate discharge and payor-related information in patient records.
• 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.
• Growth opportunities.

What This Job Offers

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