Case Manager

American Addiction Centers

1d•Onsite

About The Position

The Case Manager will conduct complete assessments, establish appropriate plans, and initiate interventions within desired timeframes. This role involves collaborating and negotiating effectively with patients, families, and the healthcare team to achieve patient and organizational goals related to care needs, choices, and satisfaction during discharge planning and care transitions. The Case Manager will utilize patient/family strengths in problem-solving, involving them and the team in decision-making from admission throughout the hospital stay. They will provide continuity of care and discharge planning services compliant with regulatory standards by offering coordinated options and services based on assessed needs, ensuring patients, families, and the healthcare team are informed and able to proceed with accountabilities in a timely manner. This includes facilitating smooth transitions for patients, families, and staff during transfers. The role also encompasses providing case management services for various levels of healthcare, finances, housing, family discord, or illness adjustment, managing family dynamics and crisis situations professionally, using community resources effectively, and educating patients/families on accessing and using services. Initiating internal and external referrals to ensure timely progression of care and transitions is also a key responsibility. Documentation of discharge planning interventions and utilization review activity per department and medical center standards is required in a timely manner. The Case Manager will perform and document accurate and timely concurrent and retrospective reviews based on approved established criteria. Effective communication with the healthcare team is essential, working in partnership with Social Work and unlicensed support personnel to establish and implement a safe plan of care. Serving as an active member of the Outcome Facilitation Team/Patient Care Multidisciplinary Team, the Case Manager will collaborate closely with medical staff, hospital departments, and ancillary services to identify and resolve barriers to discharge, expedite care delivery, and implement/report care coordination, discharge planning, and utilization management (UM) activities. Collaboration with managers, physicians, medical directors, advisory groups, and treatment teams on physician practices and best practices for the patient’s plan of care is expected. Referring cases to a physician advisor as needed to ensure efficient progression of care, accurate status, and compliance with regulatory guidelines is part of the role. Maintaining knowledge of healthcare regulations, reimbursement issues, impact on length of stay, and community resources is crucial. The Case Manager will complete UM activities as required, including providing clinical updates to payers, collecting data, coordinating denial activity, supporting UM activity, and managing avoidable delays. Delivering CMS regulatory notices within established timeframes is also required. Developing and maintaining productive relationships with community-based agencies and networks, representing Advocate Aurora Health Care positively, and working collaboratively internally and externally to meet patient/family needs are important aspects of the role. Collaboration with Advocate Aurora Ambulatory Care Management and Continuing Health to meet common goals and outcomes is expected. The Case Manager will serve as an educator and expert resource to medical and hospital staff regarding admission status, acute care criteria, utilization management issues, care coordination, discharge planning needs, and relevant regulatory requirements. The role requires the ability to demonstrate knowledge and skills necessary to provide care appropriate to the age of the patients served, understanding the principles of growth and development over the lifespan and assessing data reflective of the patient's status to identify age-specific needs and provide appropriate care.

Requirements

Registered Nurse License issued by the state in which the Team Member practices.
Bachelor’s Degree in Nursing
2 years of clinical nursing experience.
Ability to prioritize and organize work.
Effective communication skills.
Utilization of critical thinking and timely decision making.
Ability to navigate the Electronic Health Record.
Basic utilization of MS Office products.
Knowledge of Medicare A and B guidelines.
Knowledge of Managed Care program requirements/implications.
Ability to apply elements of Utilization Management programs.
Must be able to demonstrate knowledge and skills necessary to provide care appropriate to the age of the patients served.
Must demonstrate knowledge of the principles of growth and development over the life span and possess the ability to assess data reflective of the patient's status and interpret the appropriate information needed to identify each patient's requirements relative to his/her age-specific needs, and to provide the care needed as described in the department's policies and procedures.

Responsibilities

Conducts complete assessments, establishes appropriate plans, and initiates interventions within desired timeframes.
Collaborates and negotiates effectively with patient, family, and team while striving to achieve patient and organizational goals with regard to patient’s care needs, choice and satisfaction when discharge planning/transitioning care.
Utilizes patient/family strengths in the problem-solving process, involving the patient/family and team in the decision-making process beginning on admission and continuing throughout patient’s hospital stay.
Provides continuity of care and discharge planning services compliant with regulatory standards by providing coordinated relevant options and services based on assessed needs to ensure patient/family and healthcare team is informed and able to proceed with accountabilities in a timely manner.
This includes participating in the communication process to facilitate a smooth transition for patient, family, and staff when patients are transferred.
Provides case management services related to various levels of health care, finances, housing, family discord, or illness adjustment, based department scope.
This may include managing family dynamics and crisis situations in a timely and professional manner, using community resources effectively, and educating patient/family regarding access to and use of services.
Initiates internal and external referrals to assure timely progression of care and transitions.
Documents discharge planning interventions and utilization review activity per department and medical center standards in a timely manner.
Performs and documents accurate and timely concurrent and retrospective reviews based on approved established criteria as required by department standards.
Communicates effectively with the healthcare team.
Works in partnership with Social Work and unlicensed support personnel to effectively establish and implement a safe plan of care.
Serves as an active member of the Outcome Facilitation Team/Patient Care Multidisciplinary Team and works closely with medical staff, hospital departments and ancillary services in identification and resolution of barriers to discharge, expediting care delivery to avoid delays in timely service provision, and implementing and reporting care coordination, discharge planning and utilization management (UM) activities.
Collaborates with managers, physicians, medical directors, advisory groups, and treatment teams for issues related to physician practices and best practices for the patient’s plan of care.
Refers cases to physician advisor as needed to ensure efficient progression of care, accurate status, and compliance with regulatory guidelines.
Remains knowledgeable in issues of healthcare regulations, reimbursement issues, impact on length of stay and community resources.
Completes UM activities as required based on local structure to include providing clinical updates to payers and/or external review organizations, collecting data, coordinating denial activity, supporting UM activity, and managing avoidable delays.
Delivers CMS regulatory notices within CMS established timeframes, as appropriate based on-site guidelines.
Develops and maintains productive relationships with community-based agencies and networks by representing Advocate Aurora Health Care in a positive manner working collaboratively, internally, and externally, to meet patient/family needs.
Works in collaboration with Advocate Aurora Ambulatory Care Management and Continuing Health to meet common goals and outcomes.
Serves as an educator and expert resource to medical and hospital staff regarding admission status and acute care criteria, utilization management issues, care coordination and discharge planning needs, and relevant regulatory requirements.
Must be able to demonstrate knowledge and skills necessary to provide care appropriate to the age of the patients served.
Must demonstrate knowledge of the principles of growth and development over the life span and possess the ability to assess data reflective of the patient's status and interpret the appropriate information needed to identify each patient's requirements relative to his/her age-specific needs, and to provide the care needed as described in the department's policies and procedures.

Benefits

Compensation Base compensation listed within the listed pay range based on factors such as qualifications, skills, relevant experience, and/or training
Premium pay such as shift, on call, and more based on a teammate's job
Incentive pay for select positions
Opportunity for annual increases based on performance
Paid Time Off programs
Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability
Flexible Spending Accounts for eligible health care and dependent care expenses
Family benefits such as adoption assistance and paid parental leave
Defined contribution retirement plans with employer match and other financial wellness programs
Educational Assistance Program