Case Manager – PMRU (Physical Medical Rehabilitation Unit)

Cayuga Health System•Ithaca, NY

1d•Onsite

About The Position

Cayuga Health System is seeking an energetic team player to fill the role of Case Manager on its Physical Medical Rehabilitation Unit (PMRU). The Case Manager is responsible for the delivery of comprehensive care to a set of assigned patients in the PMRU. This involves the assessment of patient and care team needs and the development, implementation and evaluation of an appropriate plan of care, making changes in response to changing patient needs. The Case Manager is responsible for navigating the pre-admission process to the PMRU and partners with the Physiatrist, patient, and care teams to guide patient progression across the care continuum to ensure safe and efficient care transitions at discharge.

Requirements

Current unrestricted NYS Licensure Registered Nurse or Social Worker or related licensed Healthcare professional such as Respiratory Therapist, Physical Therapist, Speech Language Pathologist or Occupational Therapist.
Minimum of 2 years social work or case management experience in an inpatient setting highly preferred; acute/rehabilitation hospital experience preferred.
Knowledge of community-based organizations and strong communication, organizational, critical thinking and problem solving skills required.
Ability to stand, sit or ambulate for long periods.
Ability to mobilize freely around units, transport self to site locations, and perform required data entry into EMR and alternate data management systems.
Ability to transport self to customer base.
Effective oral and written communication skills in English, additional languages preferred.
Must have good organizational skills, time management skills and analytical ability in order to interpret information and carry out duties independently.
Maintains high visibility and is readily approachable.
May require some travel to outside referral sources for building relationships.

Nice To Haves

2 years social work or case management experience in an inpatient setting highly preferred
acute/rehabilitation hospital experience preferred
additional languages preferred

Responsibilities

Develops and implements individualized treatment plans, participates in interdisciplinary team meetings, and facilitates family conferences.
Maintains working knowledge of department performance standards and goals.
Works collaboratively with department manager to maintain compliance/achieve targeted outcomes.
Maintains current knowledge of federal, state and accreditation standards related to acute rehab and discharge planning requirements, including but not limited to CMS Standards of Participation.
Coordinates safe transitions, including home health arrangements, durable medical equipment (DME) needs, and referrals for follow-up care.
Guides patients through rehabilitation goals, explains rights, and ensures understanding of insurance benefits.
Serves as patient advocate and negotiates on behalf of the patient for needed care and services.
Initiates insurance authorization for admission to PMRU as needed.
Ensures patient demographics, insurance, primary care provider, and advanced directives are up to date in EMR.
Ensures documentation justifies the medical necessity of intensive therapy to prevent denied claims.
Documents in EMR in accordance to departmental policy to ensure effective care planning and care team communication.
Conducts initial assessments (including pre-admission screenings) to ensure appropriateness for rehab.
Assess patients and care support for continuing care needs to develop, implement and evaluate an effective discharge plan in collaboration with the multidisciplinary team.
Use knowledge of usual length of stay to initiate a plan for discharge.
Acts as liaison in developing positive relationships and partnership with outside referral sources.
Participates in system taskforces and other collaborative activities with community partners to support facility growth and transitions of care.
Assists in coordinating admission to unit.
Is flexible in assuming other responsibilities not noted above.
Flexible in taking additional assignments as needed to cover for planned and unplanned events.