The purpose of the Case Manager I position is to support the physician and interdisciplinary team in facilitating patient care, with the underlying objective of enhancing the quality of clinical outcomes and patient satisfaction while managing the cost of care and providing timely and accurate information to payors. The role integrates and coordinates utilization management, patient education, care facilitation, and discharge planning functions. The Case Manager I is accountable for a designated patient caseload and plans effectively to meet patient needs, manage the length of stay, and promote efficient utilization of resources.
Principal Duties And Responsibilities:
Facilitation of precertification and payor authorization processes.
Facilitation of the collaborative management of patient care across the continuum, intervening as necessary to remove barriers to timely and efficient care delivery and reimbursement.
Application of process improvement methodologies in evaluating outcomes of care.
Support and coaching of clinical documentation efforts and serving as a clinical resource for coders ensuring that documentation accurately reflects severity of illness and intensity of service.
Coordinating communication with physicians.
Ability to demonstrate knowledge and skills necessary to provide care appropriate to the patient served.
Ability to demonstrate knowledge of the principles of growth and development as it relates to the different life cycles.
Skills:
Required Skills & Experience:
Possess interpersonal communication and negotiation skills.
Possess analytical, data management and PC skills.
Organizational and time management skills, as evidenced by capacity to prioritize multiple tasks and role components with minimal supervision.
Ability to work independently and exercise sound judgment in interactions with physicians, payors, and patients and their families.
Preferred Skills & Experience:
Minimum of three years RN clinical experience, preferred.
Current working knowledge of discharge planning, utilization management, case management, performance improvement and managed care reimbursement, preferred.
Education:
Required Education:
Bachelors of Science in Nursing, required.
Preferred Education:
N/A
Required Certification & Licensure:
Current and valid license to practice as a Registered Nurse in the State of Michigan.
Preferred Certification & Licensure:
N/A
