Manager of Case Management

Salary - $53k - $58k

POSITION OVERVIEW: The Manager of Case Management will provide oversight and direction to the Case Managers. The MCM has a solid understanding of the importance of documentation, communication, and patient education in the care coordination process.

Primary responsibilities include overseeing and managing the case management team to ensure effective discharge planning and the development of comprehensive, patient-centered continued care plans. This includes scheduling aftercare appointments prior to discharge, addressing all patient needs, and prioritizing the RCA continuum of care and/or preferred providers, aligned with patient preferences, to meet individual needs. Additionally, the role ensures that transitions of care are designed to support patients in attending their follow-up appointments, promoting continuity of care and achieving the best possible longitudinal outcomes.

The MCM ensures that patient preferences, barriers to care including access and other social determinants of health are identified and addressed in the patient's continuum of care/discharge plan to help ensure success in the patient's environment.

The MCM Will Ensure Seamless Care Coordination Between Treating Providers In The Community, Referents, And Payers, Ensuring Alignment With Payer Contractual Agreements And Referent Expectations. This Includes Managing Required Coordination Of Care, Facilitating Timely Communication, And Providing Clinical Documentation As Needed The MCM Is Responsible For Continuous Quality Improvement With Identified Departmental Key Performance Indicators Including:

Patient progressions: ensuring patients advance appropriately through full Continuum of Care. Scheduled SUD/MAT, MH and PCP appointments prior to discharge Patient engagement optimizing patient stays to balance clinical needs and completion of treatment plan goals. Timely CM Admission Documentation and ongoing coordination of care with community resources (referents, integrated health providers, support systems, payors etc.) Timely Transitions of Care Family Meeting Accuracy and timely completion of the patient's individual Continuing Care/Discharge Plan including linkage to resources that address Social Determinants of Health (SDOH).

The MCM Ensures That The CM Team Is Responsible For Confirming And Or Obtaining All ROIs That Are Required To Assist The Patient Through The Care Continuum. A Release Of Information (ROI) Typically Includes:

Notification of Admission Introduction and contact information for assigned CM and Therapist Ongoing updates throughout treatment Commencement of Continued Care/Discharge planning Copy of Continued Care/Discharge Plan and summary of the Transition of Care Meeting Discharge Date Other information as requested and as approved for release via the ROI by the patient.

The MCM serves as the primary liaison between the site and the Business Development team ensuring timely communication and relationship management with referral sources.

The MCM ensures that the CM team addresses patient needs on a timely basis including legal, FMLA, STD and other outside influences that may impact patient outcomes.

Also responsible for reviewing and addressing any patient complaints and grievances related to case management responsibilities.

KEY RESPONSIBILITIES:

Interview/Hire/Onboard/Orient and hold accountable, the team of Case Managers Knowledgeable of daily facility metrics, targets and goals and identifying and communicating opportunities to improve. Ensures the CM team is also aware of daily metrics and is working toward the facility goals and objectives. Leads/participates in Multidisciplinary Care Team meetings and mentors Case Managers to become active contributors including discussing recommended discharge date, community resources, status of legal, FMLA and other factors that may impact patient outcomes and specific aftercare plan and appointments. Has a solid understanding of UR, last covered day and discusses at discharge planning, MDT and clinical huddle meetings to ensure the patient receives the right care in the right place at the right time. Educates the CM team to ensure they also understand how to manage LOS and LCD. Ensures case managers are meeting with patients and that admission assessment is documented in Avatar within 72 hrs. of admission. Case Managers are documenting at least a weekly progress note that includes patient progress toward discharge, discussions of discharge planning, actual or potential barriers to a successful aftercare plan and patient's engagement in their aftercare plan. Assumes department oversight for the FMLA and STD application process ensuring and ROI is in place to address the patient's needs, eligibility and benefits early in the patient's stay. Manages the site's Discharge Calendar on a daily basis and works with the multi-disciplinary care team to ensure all required fields are completed prior to end of day. Ensures team proactively communicates with referral sources and payers to ensures positive collaborative relationships The MCM will ensure that the CM dept. facilitates at least one weekly Continuum of Care group to inform patients of aftercare options. Maintains a Master List of Preferred Providers in coordination with the business development for discharge planning purposes Works closely with RCA OP leadership team to maximize referral potential from inpatient to outpatient care. This includes regularly scheduled Guesting, OP-IP discharge planning meetings and requesting that OP staff meet with potential IP staff to assist with discussing aftercare options. Ensures all continued care/discharge plans are solidified 1 week prior to discharge and that a Transitions of Care meeting has been scheduled at least 7 days prior to discharge with the patient, the patient's support system, and the therapist to review the recommended aftercare plan. Confirms patient preferences and barriers to care have been identified and addressed in the aftercare plan. Ensure process are in place for patient follow up: For patients who leave treatment early or unplanned without solid discharge plan, CM follow-ups will be conducted the next business day to support their transition, facilitate re-engagement in treatment, and connect them with an outpatient provider and appropriate resources if they departed without a comprehensive plan. Works collaboratively with the clinical team to engage, educate, communicate, and coordinate care with patient, their family, behavioral and general medical care providers, community resources and others to ensure that all services prescribed in the individualized continuing plan are addressed. Ensures Case Managers : Obtain any applicable signed Release of Information (ROI) forms for all identified providers and resources in the Continued Care Plan (CCP) and other patient resources/supports (Employer/FMLA, Legal, Payer programs, Peer Support, etc.) Initiate and documents all referrals specified in the CCP. Ensure effective communication of relevant information to post-discharge providers. Conduct a comprehensive review of the CCP with the patient and their support system within one week of discharge. Assess patient comprehension of the aftercare plan through verbal confirmation. Verify patient's clear understanding of post-discharge care instructions. Reviews all Case Management related reports daily or weekly as distributed and shares with CM team to build understanding of RCA strategy and objectives.

Provides weekly supervision and mentoring to all case managers to help foster a team environment, instill personal accountability and identify opportunities for improvement.

SKILLS AND EDUCATION:

Social Worker with discharge planning experience preferred.

Bachelor's Degree in social work, counseling, nursing or other related field or equivalent combination of education, training, and/or experience preferred Minimum of one (1) year experience working in a behavioral health, substance use or psychiatric field. Knowledge of health care, detoxification process, addiction, co-occurring disorders, DSM and ASAM Criteria, and terminology. Ability to read and interpret written information; write clearly and informatively; edit work for spelling and grammar. Ability to speak clearly and persuasively in positive or challenging situations; listens and asks for clarification; responds to questions or concerns; demonstrates group presentation skills; and participates in meetings. Working knowledge of Microsoft Word, Excel, and Outlook.

COMPETENCIES:

Job Knowledge: Understands duties and responsibilities of the Case Management department, possesses necessary job knowledge, technical skills, understands company mission/values, maintains current knowledge of case management, seeks clarification if additional education is needed, and is in command of critical issues. Possesses expertise in all levels of care available to patients upon discharge from RCA sites including, but not limited to, Sober Living, Extended Care, Outpatient, Psychiatry, etc..

Communication: Excellent communication skills both verbally and in writing, creates accurate and punctual reports, delivers presentations, shares information and ideas with others, has good listening skills. Actively participates in facility leadership team meetings and can discuss status of CM KPIs as well as other metrics and opportunities for improvement. Contributes to facility strategy and innovations to improve patient experience and quality outcomes.

The case management team is tasked with assuring exceptional relationships with RCA referral sources as this contributes to RCA's ability to maintain positive relationships with our referral partners.

Critical Thinking and Problem Solving

Demonstrates Exceptional Ability To Analyze Complex Patient Situations And Develop Appropriate Post-discharge Care Plans. Anticipates And Evaluates Potential Consequences Of Decisions To Ensure Patient Safety And Well-being. Takes Decisive Action Based On Thorough Analysis And Best Practices In Care Transition Management Ensuring That:

Discharge plans are tailored to individual patient needs, considering their unique circumstances and resources. The assigned case manager collaborates with patients, families, and healthcare teams to make informed decisions about post-discharge care. The CM team has the knowledge and skills to balance clinical recommendations with patient preferences to ensure realistic and effective care plans.

WORK ENVIRONMENT: This job operates in a professional office environment. This role routinely uses standard office equipment such as computers, phones, photocopiers, and filing cabinets. The noise level in the work environment is usually moderate.

PHYSICAL DEMANDS: While performing the duties of this position, the employee is regularly required to talk or hear. The employee frequently is required to use hands to handle or feel objects, tools or controls. The employee is occasionally required to stand; walk; sit; reach with hands and arms; climb or balance; and stoop, kneel, crouch or crawl. The employee must occasionally lift and/or move objects up to 25 pounds. Specific vision abilities required by this position include close vision, distance vision, color vision, peripheral vision and the ability to adjust focus.

TRAVEL: Travel is primarily local during the business day, although some out-of-the-area and overnight travel may be expected.