Case Manager Continuing Care Social Work
- Plans, develops, assesses and evaluates care provided to members.
- In conjunction with primary care and specialist physicians, evaluates and develops baseline medical and psychosocial evaluations and individualized patient care/treatment plans.
- Recommends alternative levels of care and ensures compliance with federal, state, and local requirements.
- Makes assessments of physiological and or functional status utilizing protocols.
- Initiates appropriate diagnostic testing/screening and interventions.
- Develops individualized patient/family education plan focused on self-management; delivers patient/family education specific to a disease state.
- Implements strategies to target/assess risk factors and achieve and ensure patient follow-up according to clinical and strategic measures/outcomes.
- Produces population based reports on outcomes specific to defined patient populations.
- Participates with healthcare team/providers in actualizing outcomes by planning, evaluating and implementing decisions and strategies to achieve predetermined cost, clinical, quality, utilization and service outcomes.
- Develops and maintains case management policies and procedures.
- Coordinates care/services with utilization and/or quality reviewers and monitors level and quality of care.
- Coordinates the interdisciplinary approach to providing continuity of care, including utilization management, transfer coordination, discharge planning, and obtaining all authorizations/approvals/transfers as needed for outside services for patients/families.
- Consults with internal and external physicians, health care providers, discharge planning and outside agencies regarding continued care/treatment or hospitalization or referral to support services or placement.
- Arranges and monitors follow-up appointments.
- Encourages member to follow prescribed course of care (e.g., drug therapy, physical therapy).
- Makes referrals to appropriate community services and outside providers.
- Identifies and recommends opportunities for cost savings and improving the quality of care across the continuum.
- Develops and collects data; trends utilization of health care resources.
- Interprets regulations, health plan benefits, policies, and procedures for members, physicians, medical office staff, contract providers, and outside agencies.
- Coordinates transmission of clinical and benefit treatment to patients, families and outside agencies.
- Acts as liaison for outside agencies, non-plan facilities, and outside providers.
- Coordinates repatriation of patients and monitors their quality of care.
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