JOB SUMMARY:

Coordinates management of care and ensures optimum utilization of resources, service delivery and compliance with external review agencies. Provides ongoing support and expertise through comprehensive assessment, care planning, plan implementation and overall evaluation of individual patient needs. Enhances the quality of patient management and satisfaction, to promote continuity of care and cost effectiveness through the integration of functions of case management, utilization review and management and discharge planning.

Provides ongoing support and expertise through comprehensive assessment, care coordination, plan implementation and overall evaluation of individual patient needs while ensuring patient preferences.

Serves as a patient advocate through resource utilization, discharge planning and addressing the holistic needs of the patient.

The Case Manager (CM) is responsible for providing care coordination including needs assessment and identification of care options, communication with patients and families in an interdisciplinary environment consistent with the position's qualifications, professional practices and ethical standards. The CM shall be accountable for carrying out all responsibilities in accordance with Kindred Healthcare CORE values. Promotes the hospital's mission, vision, and values.

ESSENTIAL FUNCTIONS:

• Completes documentation per workflow timeline and content requirements including completion of the Individual Plan of Care (IPoC) per CMS guidelines.
• Schedules family conferences and/or communicates with caregiver following each team conference and more often as needed to keep patient and designated caregiver informed of progress and provides appropriate information related to goal achievement, course of rehabilitation stay, and plans for discharge.
• Coordinates weekly patient care team conferences to facilitate development, monitoring and refinement of treatment plan to achieve identified patient goals and outcomes.
• Reviews the patient's assigned CMG and helps the team identify any potential missed comorbid conditions that are actively being treated during the patient's stay. Communicates any findings to the HIM team.
• If no Lead Case Manager, the CM participates as the facility representative for national CM Conference calls and communicates new information to the facility CMs.
• Assists with concurrent and retrospective utilization review activities including denials and appeals. Works with physicians to conduct peer review with payer medical director when indicated.
• Ensures clinical updates are provided to all insurance payers when due and all payer communications are documented in Meditech.
• Coordinates discharge planning needs including but not limited to; home health services, physician follow up care, durable medical equipment, medical supplies, healthcare services, outpatient therapy, dialysis, skilled nursing care, assisted living care, hospice care, private duty care, etc. Responsible for coordinating all patient care needs prior to discharge ensuring a safe thorough discharge plan. Ensures patient choice is offered and documented as per CMS' Conditions of Participation for Discharge Planning.
• Identifies trends that impact the quality, cost effectiveness, patient experience and delivery of care services and brings to departmental leadership meetings for discussion and action.
• Performs intake assessment on patient within 24 to 72 hours of admission, preferably within 48 hours.