[Hiring] Catastrophic Case Manager @SCM Associates

Role Description

The Case Manager has the responsibility to identify, assess, plan, coordinate, implement, monitor, and evaluate options and services for individuals requiring case management services. The goal of the case manager is to provide for quality, cost-effective outcomes for the client through collaboration and communication with the client, the family, the physician, and other members of the health care team. The case manager typically works from their home office, and attends several patient appointments in person per week. Local/Regional driving is required.

Responsibilities and Duties

• Processes the case utilizing client's outcome management model and tools
• Obtains written authorization for case management services as well as release of information
• Assesses the client/family to identify their strengths and resources; problems; psychosocial, financial, and medical history; current status; diagnosis; prognosis; functional status; goals; current treatment plan; and needs
• Develops a plan of care with client’s model through interdisciplinary collaboration, which identifies realistic short- and long-term goals
• Identifies, secures, and coordinates the services and resources to implement the plan
• Monitors services being provided for continued appropriateness and reports to client and carrier
• Evaluates the client’s progress, the plan, and the appropriateness of the services provided, with modifications as necessary
• Provides ongoing instruction to the client and family regarding the injury/disease process, treatment options, and present care
• Promotes the client’s/family’s self-advocacy skills to achieve maximum self-sufficiency
• Has knowledge of the benefit package as well as all available funding sources and systems of care and coordinates with the payer for authorization of payment
• Provides for in-depth reporting of outcomes encompassing clinical, functional, financial, and customer satisfaction areas
• Demonstrates effective, accurate, and timely verbal and written communication in all work situations
• Identifies and discloses all situations which might result in exposure to legal liability and/or are indicative of poor-quality care negatively affecting the client
• Frequently requires travel to patient appointments
• Performs other related duties as assigned in accordance with the necessary job function

Supervisory Responsibilities

This position has no supervisory responsibilities.

People Contact

This position requires regular contact both within the company and outside the company in order to carry out company policies and procedures. Requires abilities of persuasion and cooperation. Often deals with persons of equal or higher rank.

Decision Making

This position requires frequent decision making and the ability to plan and perform unusual or difficult work with general operation methods/procedures.

Supervision Received

This position exercises considerable latitude in determining objectives and approach to assignments. Completed work is reviewed from a long-term perspective for desired results.

Qualifications

• Registered nurse
• BSN preferred
• CCM or equivalent certification
• Three years or more of related experience and/or training or equivalent combination of education and experience

Requirements

• Ability to read, analyze, and interpret medical information, professional journals, technical procedures, governmental regulations, and standards of care
• Ability to effectively present information and respond to questions from customers, managers, and clients as appropriate
• Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals
• Ability to compute rate, ratio, and percent and to draw and interpret bar graphs
• Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists
• Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form
• Knowledge of database software, internet software, and Microsoft word processing software
• RN license in state(s) where cases are to be managed
• Valid driver’s license
• Valid automobile liability insurance
• Ability to organize and evaluate workload and prioritize projects
• Ability to meet deadlines
• Ability to complete multiple, simultaneous projects with accuracy and efficiency
• Detail orientation
• Contract-level acceptance by Paradigm of the Case Manager to manage their cases

Physical Demands

The physical demands described are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.

• While performing the duties of this job, the employee regularly is required to sit and talk or hear.
• The employee frequently is required to stand and walk.
• The employee frequently is required to use hands to finger, handle, or feel and to reach with hands and arms.
• The employee occasionally is required to stoop, kneel, or crouch.
• The employee occasionally must lift and/or move up to ten pounds.
• Specific vision abilities required by this job include close vision (clear vision at 20 inches or less), distance vision, peripheral vision, and ability to adjust focus.

Work Environment

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.

• The noise level in the work environment is usually moderate.

At Will Employment

Employment at SCM Associates, Inc. is based on mutual consent, and both the employee and SCM have the right to terminate employment at will, with or without cause, with or without advance notice.