Position Summary
A registered nurse or clinical social worker who assumes responsibility for assessments, care coordination, advocacy, and related case management activities for an assigned group of clients. Inherent in the position is the assessment of patient needs in conjunction with the client and/or family, physician, and ancillary health care providers. The goal of the activities is to ensure quality, appropriateness, and cost-effective services for the assigned clients.
The employee is responsible for commitment and understanding of the Mission and values of the organization.
Position Accountabilities
I. Assessment
Interviews clients and their families in the appropriate care setting, such as hospital, home or other facility. Obtains and documents assessment information utilizing approved procedures and forms.
Gathers appropriate information related to the client from a variety of sources, which include but are not limited to insurance companies, financial planners, attorneys, or sources significant to the client.
Identifies high risk factors, barriers to goals, and strengths that will assist the client in achieving goals.
Reports and/or assessments are clear, accurate, and based on comprehensive data collection.
(1,2,3,4,)
ll. Planning
Develops a comprehensive case management plan that addresses all pertinent areas of the assessment. Goals are measurable, time specific, and attainable. Goals are set by client in conjunction with identified decision makers for the client
As appropriate, develops an accurate, written, cost/benefit analysis, which identifies a variety of ways to meet the clients needs.
Identifies both private and community resources and incorporates them into the plan. Providing the client with appropriate supplementary information.
(1,2,3,4,)
III. Implementation
Arranges, directs, and monitors resources as they provide service to the client.
Obtains necessary authorizations and approvals to assure appropriate services and reimbursement.
Acts as a client advocate when disagreements arise with caregivers, family or agencies providing care.
(1,2,3,4)
IV. Monitoring
Provides frequent, timely reviews of the plan with the client and re-evaluates and modifies the plan based on client outcome.
Assures quality of services by gathering information from direct observation, telephone or in writing all resources involved in the client plan of care.
Is available or makes arrangements for coverage of clients at all times.
(1,2,3,4,)
V. Evaluation
Participates in quality management studies as appropriate.
Documents progress and pertinent information in the client record with each billable service and as necessary to provide complete information to other case managers who may be involved in the clients care.
(2,5,)
VI. Communication/Interface
Attends case management rounds as scheduled.
Acts as a positive role model for the company when dealing with clients and the public.
Accepts clients as assigned. Communicates to supervisor any conflicts or difficulties with client assignment.
Acts as a covering case manager as assigned.
Answers all pages, telephone calls or communications promptly and courteously.
Any changes in the plan of care are appropriately communicated.
(2,5,)
Vll. Performs other related duties as assigned or requested.
Job description statements are intended to describe the general nature and level of work being performed and are not to be construed as an exhaustive list of all responsibilities, duties, and skills required. Management reserves the right to reassign duties as needed.
The performance of this function is the reason that the job exists
There are limited employees among whom the performance of this function can be distributed
This function occupies a great deal of the employee's time
This function is highly specialized. Employees are hired for the skill/ability to perform this function
Failure to perform this function may have serious consequences
Exposure to bloodborne pathogens that requires use of personal protective equipment.
Position Qualifications
- Preferred Qualification: Case Management Certification
- Minimum Education/Certification: Bachelor's degree in nursing or social work, LCSW or MSW, preferred over BSW. Current California license
- Minimum Experience: At least two years of case management experience or equivalent. Preferably with the senior population.
- Working knowledge of the provision of health care in a variety of settings. Knowledge of community resources, insurance and care delivery systems.
