Overview The Certified Case Manager (CCM) serves as a key member of the interdisciplinary team and actively manages and directs resource utilization to achieve the highest quality outcomes during a patient's rehabilitation experience. The CCM coordinates and advocates for the patient during hospitalization and from admission to post discharge. As an effective communicator, the CCM manages information to oversee health care delivery and facilitates interdisciplinary plan of care decisions. The CCM facilitates timely communication regarding the patient's care, establishes and monitors the discharge plan implementation while identifying and addressing patient's psychosocial and support systems issues. The CCM oversees the coordination of services and manages issues in the main areas of admission and discharge, team conference and interdisciplinary plan of care communication, patient and family education, payor relations and total fiscal management. The CCM performs ongoing utilization review and acts as a liaison to the payor while assuring that cost effective treatment is provided by the team. The CCM ensures that regulations regarding patient's rights are fulfilled.
Responsibilities Coordinate admission and discharge processes and participate in team conferences and interdisciplinary plan of care communication.
Educate patients and families and address psychosocial and support system needs.
Serve as liaison to payors and oversee total fiscal management and cost-effective treatment planning.
Conduct ongoing utilization review and ensure compliance with patient rights and regulatory requirements.
Qualifications Licensure and Certification Must be qualified to independently complete an assessment within the scope of practice of the individual's discipline (e.g., RN, SW, OT, PT, ST, Rehabilitation Counseling).
If licensure is required for the discipline within the state, hold an active license.
Current CCM or ACM certification required.
Education, Training and Years of Experience For Nursing: minimum of an Associate Degree in Nursing; RN licensure with BSN preferred. A diploma is acceptable only in states where diploma is the minimum requirement for licensure/certification.
For all other eligible licensed or certified healthcare professionals: minimum of a baccalaureate degree; graduate degree preferred.
2 years of rehabilitation experience preferred.
Machines, Equipment Used General office equipment (telephone, copy machine, fax machine, calculator, computer).
Physical Requirements Good visual acuity and ability to communicate.
Ability to lift, lower, push, pull, and retrieve objects weighing a minimum of 30 pounds. Reasonable assistance may be requested for heavier tasks.
Compliance Adheres to the company's Standards of Business Conduct.
Maintains current licensure and/or certifications, if applicable.
Skills and Abilities Effective speaking, reading, writing, and communication.
Ability to coordinate, analyze, observe, make decisions, and meet deadlines in a detail-oriented manner.
Ability to work independently without supervision.
Environmental Conditions Indoor, temperature-controlled, smoke-free environment; occasional outdoor exposure.
Possible exposure to blood and body fluids.
Handicapped accessible; may work under stressful circumstances.
Proficiency or Productivity Standards Meets attendance standards and adheres to dress code including wearing ID badge.
May be required to work weekdays and/or weekends, evenings and/or night shifts as needed to meet deadlines, including holidays.
May be required to work during disasters and stay after hours to assist until relief arrives; may perform other duties as assigned.
Note: This description does not include all duties of the position and is subject to change at any time.