Case Manager

Encompass Health • Murrieta, CA

4d

About The Position

The Case Manager coordinates patient care and manages resources from admission through post-discharge, serving as a link between care delivery and patient outcomes. The role works with interdisciplinary teams to guide treatment plans based on patient needs and preferences, coordinate discharge planning, and oversee changes to plans of care. The Case Manager monitors the patient experience and supports timely access to resources and post-discharge services.

The position also involves completing assessments and required documentation, educating patients and families about rehabilitation and the Case Manager’s role, facilitating team and family conferences, reviewing case management reports and utilization data, and ensuring accurate patient-record and payor-related information. The Case Manager maintains knowledge of applicable regulations, standards, company policies, and department operations, and may participate in the case management on-call schedule as needed.

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 of practice.
• Must meet eligibility requirements for CCM® or ACM™ certification upon entry into 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 applicants, an Associate Degree in Nursing and RN licensure are required; a BSN is preferred. A diploma is acceptable only in states where it meets the minimum licensure or certification requirement.
• For other eligible licensed or certified health care professionals, a bachelor’s degree is required; a graduate degree is preferred.

Nice To Haves

• Two years of rehabilitation experience preferred.
• BSN preferred for nursing applicants.
• Graduate degree preferred for other eligible licensed or certified health care professionals.

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, payor considerations, 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 the patient and family 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 obtain 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 appropriate and timely referrals to post-discharge providers and physicians, with documentation.
• Ensure discharge and payor-related information in the patient record is accurate.
• Participate in the utilization review process, 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 continuing education opportunities.
• Company-matching 401(k).
• Employee stock purchase plan.
• Flexible spending accounts and health savings accounts.

What This Job Offers

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