Care Manager
Company: Good Shepherd Rehab
Location: Allentown
Posted on: August 4, 2022
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Job Description:
* JOB SUMMARY
* Develops an integrated link between patients, families, local
resources, insurance representatives and hospital, enhances
communication among these parties to assure appropriate and timely
utilization and access to services and exchange of information,
therapeutic interventions and advocates for the rights and needs of
patients.
* ESSENTIAL FUNCTIONS
* ASCERTAINS PATIENT'S MEDICAL, PSYCHOLOGICAL, EMOTIONAL AND SOCIAL
NEEDS
* By interviewing patient, completing initial care management
assessment, screening for potential discharge planning needs,
communicating with treatment team.
* DEVELOPS THERAPEUTIC INTERVENTION PLAN ACCORDING TO NEEDS
* By exploring options, setting goals, establishing rapport with
patient and significant others.
* OBTAINS SERVICES AND RESOURCES FOR PATIENT
* By ascertaining appropriateness and referring to community
resources
* Establishing rapport with agencies and support groups
* Arranging appointments
* REPRESENTS RIGHTS AND NEEDS OF PATIENTS
* By educating and informing patients about their rights
* Advocating on their behalf with community resources, insurers,
treatment team
* COORDINATES TREATMENT AND DISCHARGE PLAN
* By leading interdisciplinary team meetings
* Bridging communication between team members, ancillary
departments, insurers and significant others.
* MAINTAINS DOCUMENTATION
* By appropriate and timely notations in the medical record,
departmental files, hand-off communication documents (i.e. POD
report), electronic documentation systems and databases.
* ADDRESSES PATIENT SAFETY
* By identifying and communicating patient safety issues to the
team, patient/family
* Relaying recommendations for a safe discharge plan to
patient/family
* Assisting to resolve care issues by making referrals to address
identified needs
* Reporting to regulatory agencies as required, facilitating
appropriate utilization of services.
* Coordinates UTILIZATION MANAGEMENT ProcessES
* By reviewing clinical information based upon admission and
continued stay criteria
* Performing concurrent medical reviews to communicate to
payers
* Initiating physician advisor reviews for cases not meeting
established criteria for admission and/or continued stay to
facilitate appropriate utilization of services
* Communicating denials from third party payers to the physician
and coordinating a timely appeals process
* Updating demographic information,
* Obtaining signatures on admission paperwork and/or advance
directives forms (where applicable)
* DEMONSTRATES A PROFESSIONAL DEMEANOR AND MAINTAINS PROFESSIONAL
KNOWLEDGE
* By being flexible, responding positively to unexpected changes in
the work load and work hours
* Performing other duties as directed
* Keeping abreast of regulations and policies related to
utilization management and discharge planning, departmental staff
meeting information.
* QUALIFICATIONS
* To perform this job successfully, an individual must be able to
perform each essential duty satisfactorily. The requirements listed
below are representative of the knowledge, skill, and/or ability
required. Reasonable accommodations may be made to enable
individuals with disabilities to perform the essential
functions.
* Education
* Bachelor's Degree required
* Master's Degree preferred
* Work Experience
* 1-2 years of related experience required
* Licenses / Certifications
* Clinical license in appropriate discipline required
Keywords: Good Shepherd Rehab, Allentown , Care Manager, Executive , Allentown, Pennsylvania
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