Case Manager II

Encompass Health - Marlborough, MA

Full-time - Mid Level

Marlborough, MA

101-250 employees

Hospitals

About the position

The Case Manager role at Encompass Health is a pivotal position that connects exceptional patient care with transformative outcomes. This position allows you to utilize your clinical expertise to manage resources, coordinate patient care from admission to post-discharge, and oversee interdisciplinary care plans, all while contributing to the well-being of individuals in your community.

Responsibilities

• Manage resources and coordinate patient care from admission to post-discharge.
• Oversee interdisciplinary plan-of-care decisions.
• Work with an interdisciplinary team to guide treatment plans based on patient needs and preferences.
• Establish tentative discharge plans and contingency plans with the interdisciplinary team.
• Participate in planning and executing the patient discharge experience.
• Monitor patient experience regarding quality, timeliness, service appropriateness, payors, and expectations.
• Facilitate weekly team conferences and coordinate treatment plan modifications.
• Complete case management addendums and required documentation.
• Maintain knowledge of regulations, company policies, and department operations.
• Review and analyze case management reports, including Key Care Indicators, and plan appropriate actions.
• Understand commercial contract levels, exclusions, payor requirements, and recertification needs.
• Attend Acute Care Transfer (ACT) meetings to identify trends and collaboratively reduce ACTs.
• Meet with patients/families within 24 hours of admission per Patient Arrival and Initial Visit Standard.
• Perform assessments of goals and complete case management addendums within 48 hours of admission.
• Educate patients/families on rehabilitation and the Case Manager role; establish a communication plan.
• Schedule and facilitate family conferences as needed.
• Assist patients with timely procurement and planning of resources to avoid discharge delays or issues.
• Monitor compliance with regulations for orthotics and prosthetics ordering and payment.
• Make appropriate and timely referrals, including documentation to post-discharge providers/physicians.
• Ensure accuracy of discharge and payor-related information in the patient record.
• Participate in the utilization review process: data collection, trend review, and resolution actions.
• Participate in the case management on-call schedule as needed.

Requirements

• Must be qualified to independently complete an assessment within the scope of practice of his/her discipline (e.g., RN, SW, OT, PT, ST, Rehabilitation Counseling).
• Must hold an active license if required for one's discipline within the state.
• Must meet eligibility requirements for CCM® or ACM certification upon entry into this position or within two years of entry.
• CCM® or ACM certification required or must be obtained within two years of being placed in the Case Manager II position.
• For Nursing, must possess a minimum of an Associate Degree in Nursing, RN licensure with BSN preferred; a diploma is acceptable only in states where it is the minimum requirement for licensure.
• For all other eligible licensed or certified health care professionals, must possess a minimum of a bachelor's degree; a graduate degree is preferred.
• 2 years of rehabilitation experience preferred.

Nice-to-haves

• Experience in a rehabilitation setting.
• Strong communication and interpersonal skills.
• Ability to work collaboratively in a team environment.

Benefits

• Affordable medical, dental, and vision plans for employees and their families.
• Generous paid time off that accrues over time.
• Opportunities for tuition reimbursement and continuous education.
• Company-matching 401(k) and employee stock purchase plans.
• Flexible spending and health savings accounts.