Case Managers coordinate, negotiate, procure and manage the care and services of patients across the continuum of care. This includes admission to the correct level of care, discharge planning, utilization review, resource utilization and proactive intervention for core measures. Case Managers work collaboratively with the interdisciplinary team to give quality, compassionate patient care through effective utilization of resources. Case Managers assume a leadership role in achieving clinical, financial and resource utilization outcomes. Case Manager must be self-directed and able to tolerate frequent interruptions with a demanding workload. Case Managers must have knowledge of funding options, facility and community resources, out of area resources, clinical standards and outcomes, and nationally recognized criteria for admission and continued stays. This position is required to work every other weekend.

Primarily accountable for:

• Utilization review

• Discharge planning

• Resource Management

• Interdisciplinary communication and meetings

• Denial and appeals management

• Problem solving

• Management of frequent readmit or ED visits

• Covers for Social Work when not available. See Medical Social Work job description.

Essential Functions

1. Responsible for provision of medical social services in all patient settings, including inpatient, out patient, Family Birth Center and Emergency Department. Works with patients and families in crisis. Sets up care conferences, facilitates discussion with physicians, other staff, and other care providers.

2. Perform Utilization Review on all patients admitted inpatient and observation upon admission and regularly as patients medical status changes.

3. Perform initial insurance review and concurrent review as contractually defined.

4. Acknowledge patients' rights on confidentiality issues, maintains patient confidentiality at all times, and adheres to HIPAA guidelines and regulations.

5. Discharge planning, resources and referrals.

6. Works closely with House Supervisors on utilization review and census management.

7. Other duties as requested.

8. Covers for Social Services when not available. See Social Services job description.

Organizational Expectations

Provides a positive and professional representation of the organization.

Promotes culture of safety for patients and employees through proper identification, reporting, documentation, and prevention.

Maintains hospital standards for a clean and quiet environment.

Maintains competency and knowledge of current standards of practice, trends, and developments in related scope of job role or practice.

Participates in ongoing quality improvement activities.

Maintains compliance with organization’s policies, as well as established practices, protocols, andprocedures of the position, department, and applicable professional standards.

Complies with organizational and regulatory policies for handling confidential information.

Demonstrates excellent customer service through his/her attitude and actions, consistent with the standards contained in The Gritman Way.

Functional Demands

Population Served
Neonate, pediatric, adolescent, adult and geriatric. All genders, race, ethnic, sociopolitical, demographic, marital and sexual preference groups, developmental and physical abilities, mental illness, religions, and nationalities.

Physical Demands
- Lifting: Occasional <5 lbs. floor to waist and 1lb. overhead, 1x per day. Items lifted: binders, charts, books.
- Transfers: None
- Carry: <5 lbs, 300+ yards, i.e. clipboards and charts.
- Fine Motor: Required for writing and computer tasks.
- Computer: 90 minutes-3 hours in one day with 50% data entry and 50% mouse work. 3-4 hours of handwriting in charts in sitting and standing positions. 2 hours per day spent in patient and family meetings. 1 hour per day of phone use up to 15 minutes at one time.
- Sitting: Up to 3-7 hours per day, at various increments.
- Driving: Infrequent, 30 minutes to 2 hours in one day.

Environmental Conditions
Regularly exposed to bloodborne diseases. Contact with patients under a wide variety of circumstances. Exposed to unpleasant elements (accidents, injuries, illnesses, and death). Subject to varying and unpredictable situations. Occasionally subjected to irregular hours.