Case Manager coordinates the overall interdisciplinary plan of care for patients, from admission to discharge. Monitors care and acts as a liaison between patient/family, healthcare personnel, and insurers. Being a Case Manager evaluates the needs of the patient, the resources available, and recommends and facilitates the plan for the best outcome. Develops a discharge plan that provides the best available resources to meet ongoing patient needs and that encourages compliance with medical advice. Additionally, Case Manager identifies patient care issues and suggests revisions to or new clinical pathways to improve quality of care. May also be responsible for conducting utilization reviews. Typically requires a bachelor’s degree of Nursing. Typically reports to a head of a department/unit. Requires Registered Nurse (RN). Case Manager’s years of experience requirement may be unspecified. Certification and/or licensing in the position’s specialty is the main requirement.
Case Manager Job Description Template
Our company is looking for a Case Manager to join our team.
Responsibilities:
- Adhere to policies and procedures and take corrective action where necessary;
- Engage in effective communication and delivery according to Service Level Agreements;
- Take ownership of escalated and unresolved queries and ensure they are resolved timeously and effectively;
- Ensure the effective, accurate and timeous completion of relevant documentation accompanying transactions;
- Ensure the consistent and correct application of exclusions;
- Adhere to organizational best practice and legislative requirements;
- Drive and support effective teamwork within the department;
- Adhere to all procedures and processes to improve service delivery;
- Ensure discharge planning is done and arrange post-hospital care where necessary;
- Engage in appropriate training interventions to promote own professional development;
- Ensure Service Level Agreements are met and exceeded;
- Manage the cost of an in or out-patient episode by implementing appropriate policies and guidelines;
- Ensure to demonstrate the company’s values on a daily basis;
- Provide clear communication to all parties involved in an investigation with regards to the outcomes and process;
- Educate and guide all members regarding health care and their benefits.
Requirements:
- Clinical background essential;
- Computer literate with strong administration and organizational skills;
- Application of clinical knowledge in the risk management of patients in terms of length of stay and level of care is essential;
- Minimum of four years’ experience as a Case Manager or similar, with knowledge of current coding structures in the SA Health Care Environment;
- Knowledge and understanding of all funders;
- Own transport and valid drivers license;
- Account knowledge to action EDI’s;
- Ability to build rapport and empathy with customers during difficult times;
- Medical, vocational or rehabilitation background is desirable.