Clinical Case Manager

Encompass Health • Edgewood, KY

5d

About The Position

The Clinical Case Manager at Encompass Health coordinates patient care and manages resources from admission through post-discharge. The role works with interdisciplinary teams to guide treatment plans, coordinate discharge planning, and support patient and family needs throughout the rehabilitation journey. The position is PRN, as needed Monday through Thursday, on day shift, and may participate in the case management on-call schedule as needed.

The Case Manager monitors patient experience, care quality, service appropriateness, payor requirements, and treatment-plan progress. The role also supports utilization review, maintains required documentation, makes referrals to post-discharge providers, and helps ensure timely and accurate discharge planning.

Requirements

• Must be qualified to independently complete an assessment within the scope of practice of the individual's discipline, such as RN, SW, OT, PT, ST, or Rehabilitation Counseling.
• If the individual's discipline requires state licensure, must hold an active license.
• 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 being placed in the Case Manager II position.
• For Nursing, must have at least an Associate Degree in Nursing and RN licensure. A BSN is preferred; a diploma is acceptable only in states where it is the minimum licensure or certification requirement.
• Other eligible licensed or certified health care professionals must have at least a bachelor's degree; a graduate degree is preferred.

Nice To Haves

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

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 plans 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 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 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 procure and plan resources in a timely manner to avoid discharge delays or issues.
• Monitor compliance with regulations for ordering and payment of orthotics and prosthetics.
• Make timely and appropriate 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 and health savings accounts.

What This Job Offers

• Career Level: Mid Level
• Education Level: Associate degree