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Description

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Summary:

+ The Case Manager Coordinates discharge planning, patient teaching and other associated activities for successful discharge community/home re-entry or to nursing facilities. In inpatient rehabilitation, medical case management involves coordinating a patient's care, ensuring access to resources, and supporting their recovery journey. Completes, monitors and assures compliance with Federal, State and Third-Party Insurance guidelines. This includes working with the healthcare team to develop and implement a rehabilitation plan, monitoring the patient's progress, and assisting with discharge planning. Case managers also advocate for the patient's needs and ensure quality, cost-effective care

Responsibilities:

+ 1. **Monitors UR activities/resource utilization** a. Reviews for appropriateness of admission and continued stay

1.

1. Obtains patient precertification to prevent possible payor denials

2. Appropriately follows through with Payor Denials with appeal process

3. Confers with physician and/or refers to physician consultant when “Medical necessity” for admission or continued stay is questioned

1.

1. Completes chart review within 24 working hours and obtains precertification within 48 working hours to appropriately monitor UR activities and prevent payor denials.2. **Interviews patients/families and records in Medical Record, Makes referrals.**

1.

1. Documenting psychosocial, financial, cultural, domestic violence and protective services situations. Refers if necessary.

2. Develops plan to meet needs

3. Provides brief counseling services

4. Completes case findings, assessments, and treatment plans as per policy in order to provide effective intervention.3. **Coordinates/promotes patient teaching.**

1.

1. Provides education and implementation of AMD and DNR, documents to patients as needed

2. Provides and identifies appropriate resources to meet educational needs of staff, patient, physician or community agency

3. Coordinates activities in conjunction with other multidisciplinary team members to meet educational needs.4. **Coordinates discharge planning between community agencies, interdisciplinary team, patients/families and physicians.**

1.

1. Identifies appropriate level of care for nursing home placement/extended care

2. Completes FL2, PASARR approval process

3. Maintains working knowledge of financial and community resource regulations/availability

4. Coordinates continuity of care in order to facilitate transition from LMH.5. **Serves as a resource person for families, staff, community agencies and physicians.**

1.

1. Assists with learning needs of staff

2. Participates in job-related seminars and in service education

3. Serves on hospital committees addressing managed care/length of stay

4. Utilizes resources as appropriate

5. Collaborates with other health care professionals in order to provide comprehensive quality care to patients and families.6. **Demonstrates Autonomy.**

1.

1. Completes tasks as assigned

2. Seeks and accepts additional job responsibilities and learning experiences

3. Sets priorities according to patient needs

4. Operates within parameters of hospital and department policies

5. Demonstrates appropriate time management

6. Seeks opportunities for professional growth

7. Takes personal responsibility and initiative for performance and for professional growth and development.7. **Coordinates/promotes patient teaching.**

1.

1. Promotes education and implementation of AMD and DNR, documents to patients as needed.

2. Provides and identifies appropriate resources to meet education needs of staff, patient, physician or community agency.

3. Coordinates activities to facilitate learning in accordance to needs assessment.

4. Includes patient/family and/or significant other in patient education plan.

Other Information

Other information:

+ **EDUCATION**

+ Graduate from an accredited school of nursing or Medical Social Worker. Baccalaureate Degree in Human Services area accepted. Obtain Case Manager Certification within 5 years encouraged.

+ **EXPERIENCE**

+ Two-Three years experience in hospital, nursing home, or community agency.

+ **LICENSURE/REGISTRATION/CERTIFICATION**

+ Certification by American Board of QA/UR or InterQual

+ Certification in Social Work

+ Licensed in N.C. for RN

Job Details

Legal Employer: Lenoir Health

Entity: UNC Lenoir Health Care

Organization Unit: Ip Rehab Facility

Work Type: Full Time

Standard Hours Per Week: 36.00

Salary Range: $26.72 - $32.07 per hour (Minimum to Midpoint )

Pay offers are determined by experience and internal equity

Work Assignment Type: Onsite

Work Schedule: Day Job

Location of Job: US:NC:Kinston

Exempt From Overtime: Exempt: No

Qualified applicants will be considered without regard to their race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.