Responsible for coordinating and facilitating comprehensive care for patients throughout their hospital stay. This role involves assessing, planning, and monitoring the care provided to patients, ensuring that they receive high-quality care and appropriate services. The Case Manager works closely with healthcare teams, patients, and families to promote optimal patient outcomes, ensure smooth transitions, and minimize healthcare costs.
RESPONSIBILITIES
Key Responsibilities:

Discharge Planning: Develop and implement effective discharge plans for safe transitions from hospital to home or another facility.
Ensure Compliance: Maintain accurate documentation and ensure adherence to hospital policies and regulatory standards.
Advocate for Patients: Support patients and families, addressing concerns and ensuring their needs are met.
Provide clinical expertise for managing insurance claims with the supportive medical justifications based on good clinical practice.
Coordinate Patient Care: Ensure seamless communication and care coordination across the healthcare team.
Ensure the efficient use of hospital resources by coordinating care to reduce unnecessary services and minimize patient readmissions, thereby helping to control healthcare costs.
Work with insurance companies and billing departments to ensure appropriate coverage and reimbursement for patient care services.
Identify opportunities to reduce patient care costs while maintaining quality outcomes, such as avoiding prolonged hospital stays or ensuring timely discharge.
 

Specific Responsibilities for this Role

Coordinate follow-up care, including home health services, rehabilitation, and community resources.

Provide patients and families with education about post-discharge care, medications, and rehabilitation options.
Act as a liaison between patients, families, and the healthcare team to ensure that the patient’s needs and preferences are addressed.
Provide emotional support and information to patients and families, helping them understand treatment options and care plans.
Identify and arrange for necessary resources such as durable medical equipment, home care services, and community programs.
Work within budgetary constraints to minimize hospital readmissions and avoid unnecessary care services.
Ensure all care plans, documentation, and interactions comply with hospital policies, regulatory standards, and accreditation requirements.
Maintain accurate and timely documentation of patient assessments, care plans, progress notes, and discharge information.
Act as a key member of the multidisciplinary healthcare team, attending rounds, meetings, and case discussions.
Communicate effectively with patients, family members, healthcare providers, and insurance companies to facilitate appropriate care.
Participate in continuous quality improvement initiatives to enhance patient care, reduce readmissions, and improve hospital efficiency.
Monitor patient outcomes and adjust care plans to address changing needs.
Conduct comprehensive assessments of patients' medical, social, psychological, and financial needs upon admission.
Evaluate the patient's condition, treatment plan, and care requirements to ensure appropriate care services are provided.
Develop, implement, and monitor personalized care plans in collaboration with physicians, nurses, social workers, and other healthcare professionals.
Ensure that patients receive timely and efficient care by coordinating activities, appointments, and services within the hospital.
Create detailed discharge plans for patients, ensuring a smooth transition from hospital to home or another care setting.
QUALIFICATIONS
.Minimum of 3 years of experience in a hospital or clinical setting, with experience in case management preferred.
Knowledge of healthcare systems, insurance processes, and discharge planning.
Bachelor’s degree or Diploma in Nursing or Medicine
Non-licensed Physician