Manager of Case Management

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 Ava