Assist with Case Management and discharge planning on the TRCU and other areas as assigned.
Often case managers execute their responsibilities across settings, providers, over time, and beyond the boundaries of a single episode of care. They also employ the use of health and information technology and tools. The role functions of professional case managers may include, but are not limited to, the following:
· Considering predictive modeling, screening, and other data, where appropriate, in deciding whether a client would benefit from case management services.
· Conducting an assessment of the client’s health, physical, functional, behavioral, psychological, and social needs, including health literacy status and deficits, self-management abilities and engagement in taking care of own health, availability of psychosocial support systems including family caregivers, and socioeconomic background. The assessment leads to the development and implementation of a client-specific case management plan of care in collaboration with the client and family or family caregiver, and other essential health care professionals.
· Identifying target care goals in collaboration with the client, client’s family or family caregiver, and other members of the health care team. Securing client’s agreement on the target goals and desired outcomes.
· Planning the care interventions and needed resources with the client, family or family caregiver, the primary care provider, other health care professionals, the payer, and the community-based agents, to maximize the client’s health care responses, quality, safety, cost-effective outcomes, and optimal care experience.
· Facilitating communication and coordination among members of the inter-professional health care team, and involving the client in the decision-making process in order to minimize fragmentation in the services provided and prevent the risk for unsafe care and suboptimal outcomes.
· Collaborating with other health care professionals and support service providers across care settings, levels of care, and professional disciplines, with special attention to safe transitions of care.
· Coordinating care interventions, referrals to specialty providers and community-based support services, consults, and resources across involved health providers and care settings.
· Communicating on an ongoing basis with the client, client’s family or family caregiver, other involved health care professionals and support service providers, and assuring that all are well-informed and current on the case management plan of care and services.
· Educating the client, the family or family caregiver, and members of the interdisciplinary professional health care team about treatment options, community resources, health insurance benefits, psychosocial and financial concerns, and case management services, in order to make timely and informed care-related decisions.
· Counseling and empowering the client to problem-solve by exploring options of care, when available, and alternative plans, when necessary, to achieve desired outcomes.
· Completing indicated notifications for and pre-authorizations of services, medical necessity reviews, and concurrent or retrospective communications, based on payer’s requirements and utilization management procedures.
· Ensuring the appropriate allocation, use, and coordination of health care services and resources while striving to improve safety and quality of care, and maintain cost effectiveness on a case-by-case basis.
· Identifying barriers to care and client’s engagement in own health; addressing these barriers to prevent suboptimal care outcomes.
· Assisting the client in the safe transitioning of care to the next most appropriate level, setting, and/or provider.
· Striving to promote client self-advocacy, independence, and self-determination, and the provision of client-centered and culturally-appropriate care.
· Advocating for both the client and the payer to facilitate positive outcomes for the client, the inter professional health care team, and the payer. However, when a conflict arises, the needs of the client must be the number one priority.
· Evaluating the value and effectiveness of case management plans of care, resource allocation, and service provision while applying outcomes measures reflective of organizational policies and expectations, accreditation standards, and regulatory requirements.
· Engaging in performance improvement activities with the goal of improving client’s access to timely care and services, and enhancing the achievement of target goals and desired outcomes.