Clinical Case Manager

Encompass Health•Edgewood, KY

About The Position

Encompass Health is seeking a Case Manager to coordinate patient care and resources from admission through post-discharge, and oversee interdisciplinary plan-of-care decisions. The role uses clinical expertise to support patient well-being and meaningful rehabilitation outcomes. The Case Manager works with patients, families, and interdisciplinary teams to guide treatment plans, develop discharge plans, monitor the patient experience, and coordinate services and referrals. The position also supports utilization review, regulatory compliance, documentation, and timely, accurate discharge and payor-related processes.

Requirements

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.
Hold an active license if licensure is required for the discipline in the state of practice.
Meet eligibility requirements for CCM® or ACM™ certification upon entry into the position or within two years of entry.
Hold CCM® or ACM™ certification, or obtain it within two years of placement in the Case Manager II position.
For nursing professionals, possess at least an Associate Degree in Nursing and RN licensure. 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, possess at least a bachelor's degree.

Nice To Haves

A BSN for nursing professionals.
A graduate degree for eligible licensed or certified health care professionals outside nursing.
Two 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 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.
Assist patients with timely procurement and planning of resources to prevent discharge delays or issues.
Monitor compliance with regulations for orthotics and prosthetics ordering and payment.
Make timely, appropriate referrals to post-discharge providers and physicians, with documentation.
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.