Case Manager

Encompass Health•Sewickley, PA

About The Position

The Case Manager at Encompass Health coordinates patient care and manages resources from admission through post-discharge. The role uses clinical expertise to guide interdisciplinary plan-of-care decisions, support patient and family needs, and help deliver meaningful rehabilitation outcomes. The Case Manager works with the interdisciplinary team to plan treatment and discharge, monitor the patient experience, and coordinate appropriate post-discharge resources and referrals.

Requirements

Must be qualified to independently complete an assessment within the scope of practice of the applicable 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 discipline in the state.
Must meet eligibility requirements for CCM® or ACM™ certification upon entering 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, an Associate Degree in Nursing and RN licensure are required; a BSN is preferred. A diploma is acceptable only in states where it is the minimum requirement for licensure or certification.
For other eligible licensed or certified healthcare professionals, a minimum bachelor's degree is required.

Nice To Haves

A BSN for nursing candidates.
A graduate degree for other eligible licensed or certified healthcare professionals.
Two years of rehabilitation experience.

Responsibilities

Guide treatment plans with the interdisciplinary team 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 applicable 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, payor requirements, and recertification needs.
Attend Acute Care Transfer meetings to identify trends and collaborate on reducing 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 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 manner to avoid discharge delays or issues.
Monitor compliance with regulations for orthotics and prosthetics ordering and payment.
Make timely and appropriate referrals, with documentation, to post-discharge providers and physicians.
Ensure discharge and payor-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.