Case Manager

clearskyhealth; Waxahachie (TX); On-site; USD 65,000 - 90,000; Full time

Job summary

clearskyhealth in Waxahachie, TX is seeking a Case Manager to collaborate with physicians and the multidisciplinary team to develop and monitor a plan of care for assigned patients. You will participate in discharge planning, assess barriers to care, and ensure timely communication with payors and clinical staff, while upholding safety and accreditation standards.

This role requires a relevant bachelor’s degree or clinical licensure and at least four years of experience; acute care setting

Qualifications

• Relevant Bachelor's degree; OR
• Current state clinical licensure; OR
• 4 years relevant experience required.
• Acute care setting preferred.

Responsibilities

• Develops a plan of care for assigned patients in collaboration with physicians and the multidisciplinary team.
• Monitors progress and facilitates discharge planning to ensure timely and safe patient transitions.
• Identifies barriers to care and resolves issues affecting quality and outcomes.
• Documents care coordination, medical necessity, and post-discharge needs in the health care record.
• Communicates with payors and clinical team to ensure timely updates and authorizations.
• Maintains safety standards and adheres to accreditation requirements (TJC and CMS).
• Completes required trainings and supports organization-wide effectiveness.

Skills

Critical thinking

Clinical operations knowledge

Excellent communication

Interdisciplinary collaboration

Confidentiality and ethics

Education

Bachelor's degree in relevant field

Current state clinical licensure

Job description

Our hospital provides high-quality care that transforms the lives of those living with disabling injuries and illnesses. We distinguish ourselves through our commitment to excellence, to our patients, to our employees, and to the communities we serve.

The Case Manager works with physicians and multidisciplinary team members to develop a plan of care for assigned patients. Ensures patient is progressing towards desired outcomes by monitoring care through assessments and/or patient records. Identifies and resolves barriers that hinder effective patient care. Actively involved in discharge planning process. This position must integrate company values into daily practice.

Essential Functions

Communicates, collaborates, and coordinates with team members to provide quality patient care and to ensure positive patient outcomes. Facilitates communication during interdisciplinary team conference.

Responsible for accreditation standards and adheres to all standards set forth by the State and accrediting agencies of TJC and CMS.

Documents communication and coordination or patient activities, medical necessity, and post discharge equipment and support needs in the health care record.

Supports and facilitates length of stay management. Conducts utilization reviews.

Communicates appropriate information for timely updates and authorizations with payors. Ensures the outcome of this information is timely communicated to clinical team and administration.

May be required to work during inclement weather and other staffing emergencies.

Provides an environment conducive to safety for patients, visitors, and staff. Assesses the risks for safety and implements appropriate precautions. Complies with appropriate and approved safety and Infection Prevention standards.

Completes required trainings, as assigned.

Performs other duties as assigned to support overall effectiveness of the organization.

Minimum Job Requirements

Minimum Education & Experience

• Relevant Bachelor's degree; OR
• Current state clinical licensure; OR
• 4 years relevant experience required.
• Acute care setting preferred.

Required Licenses, Certifications, and/or Documentation

• Clinical licensure required when required by state.
• Must maintain acceptable driving record, current driver's license, and insurability.

Required Knowledge, Skills, and Abilities

• Demonstrates an understanding of treatment costs and financial support as they relate to quality and efficiency.
• Demonstrates critical thinking skills: Using logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions or approaches to problems.
• Knowledge of community resources to meet post-discharge clinical and social needs.
• Knowledge of clinical operations and procedures.
• Ability to establish and maintain pro-active relationships with internal interdisciplinary team members, insurance companies, physicians, referral sources, community service organizations and health care facilities.
• Ability to maintain quality, safety, and/or infection prevention standards.
• Demonstrates general computer skills including data entry, word processing, email, and record management.
• Effective organizational and time management skills.
• Effective written and verbal communication skills.
• Ability to maintain proper levels of confidentiality.
• Ability to work closely and professionally with others at all levels of the organization.

Physical Requirements Over the Course of a Shift

• A significant amount of standing and walking.
• Lifting/exerting of up to 25 lbs.
• Possible exposure to bodily fluids.
• Visual acuity required for patient assessment and documentation.
• Acute hearing required for accurate patient assessment.
• Sufficient manual dexterity to operate equipment and computer keyboard.
• Close vision and the ability to adjust focus.