Case Manager - Inpatient Behavioral Health
Company: Advocate Health
Posted on: November 16, 2023
- Conducts complete assessments, establishes appropriate plans,
and initiates interventions within desired timeframes. Collaborates
and negotiates effectively with patient, family, and team while
striving to achieve patient and organizational goals with regard to
patient's care needs, choice and satisfaction when discharge
planning/transitioning care. Utilizes patient/family strengths in
the problem-solving process, involving the patient/family and team
in the decision-making process beginning on admission and
continuing throughout patient's hospital stay.
- Provides continuity of care and discharge planning services
compliant with regulatory standards by providing coordinated
relevant options and services based on assessed needs to ensure
patient/family and healthcare team is informed and able to proceed
with accountabilities in a timely manner. This includes
participating in the communication process to facilitate a smooth
transition for patient, family, and staff when patients are
- Provides case management services related to various levels of
health care, finances, housing, family discord, or illness
adjustment, based department scope. This may include managing
family dynamics and crisis situations in a timely and professional
manner, using community resources effectively, and educating
patient/family regarding access to and use of services.
- Initiates internal and external referrals to assure timely
progression of care and transitions. Documents discharge planning
interventions and utilization review activity per department and
medical center standards in a timely manner. Performs and documents
accurate and timely concurrent and retrospective reviews based on
approved established criteria as required by department
- Communicates effectively with the healthcare team. Works in
partnership with Social Work and unlicensed support personnel to
effectively establish and implement a safe plan of care. Serves as
an active member of the Outcome Facilitation Team/Patient Care
Multidisciplinary Team and works closely with medical staff,
hospital departments and ancillary services in identification and
resolution of barriers to discharge, expediting care delivery to
avoid delays in timely service provision, and implementing and
reporting care coordination, discharge planning and utilization
management (UM) activities.
- Collaborates with managers, physicians, medical directors,
advisory groups, and treatment teams for issues related to
physician practices and best practices for the patient's plan of
care. Refers cases to physician advisor as needed to ensure
efficient progression of care, accurate status, and compliance with
- Remains knowledgeable in issues of healthcare regulations,
reimbursement issues, impact on length of stay and community
resources. Completes UM activities as required based on local
structure to include providing clinical updates to payers and/or
external review organizations, collecting data, coordinating denial
activity, supporting UM activity, and managing avoidable delays.
Delivers CMS regulatory notices within CMS established timeframes,
as appropriate based on-site guidelines.
- Develops and maintains productive relationships with
community-based agencies and networks by representing Advocate
Aurora Health Care in a positive manner working collaboratively,
internally, and externally, to meet patient/family needs. Works in
collaboration with Advocate Aurora Ambulatory Care Management and
Continuing Health to meet common goals and outcomes.
- Serves as an educator and expert resource to medical and
hospital staff regarding admission status and acute care criteria,
utilization management issues, care coordination and discharge
planning needs, and relevant regulatory requirements.
- Must be able to demonstrate knowledge and skills necessary to
provide care appropriate to the age of the patients served. Must
demonstrate knowledge of the principles of growth and development
over the life span and possess the ability to assess data
reflective of the patient's status and interpret the appropriate
information needed to identify each patient's requirements relative
to his/her age-specific needs, and to provide the care needed as
described in the department's policies and procedures. Age-specific
information is developed further in the departmental job standards.
License/Registration/Certification: Registered Nurse License issued
by the state in which the Team Member practices. Level of
Education: Bachelor's Degree in Nursing Years of Experience: 2
years of clinical nursing experience. KNOWLEDGE SKILLS AND
- Ability to prioritize and organize work.
- Effective communication skills.
- Utilization of critical thinking and timely decision
- Ability to navigate the Electronic Health Record.
- Basic utilization of MS Office products.
- Knowledge of Medicare A and B guidelines.
- Knowledge of Managed Care program
- Ability to apply elements of Utilization Management programs.
- Must be able to sit up to approximately 50 percent of the
workday; stand and walk for the equivalent of several blocks at a
- Must lift up to 10 lbs. continuously, up to 20 lbs. frequently,
and up to 50 lbs. occasionally.
- Manual dexterity required for operation computer and
- Visual acuity required for facilitating review of written
documents/computer screens, medical records, and to record
- Clear verbal communications and hearing acuity required for
receiving instructions and converse on standard telephone.
- Functional speech and hearing to allow for effective
communication of instructions and conversation over the
- Exposed to normal office environment; including usual hazards
related to operating electrical equipment.
- Operates all equipment necessary to perform the job. This job
description indicates the general nature and level of work expected
of the incumbent. It is not designed to cover or contain a
comprehensive listing of activities, duties or responsibilities
required of the incumbent. Incumbent may be required to perform
other related duties.
Keywords: Advocate Health, Sheboygan , Case Manager - Inpatient Behavioral Health, Healthcare , Sheboygan, Wisconsin
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