Case Manager-BR in Blue Ridge, Georgia at Georgia Mountains Health Services, Inc.

CASE MANAGER JOB DESCRIPTION

POSITION SUMMARY

The Case Manager is primarily responsible for coordination of patient care both within and outside of Georgia Mountains Health including community resources, labs, specialists and hospitals. The Case Manager is responsible for being informed, reaching out and establishing relationships with community providers and resources in order to provide patients with service resources and ensure communication and results are communicated appropriately, consistently and without delay.

The Case Manager develops interdisciplinary care plan and other case management tools by participating in meetings; coordinating information and care requirements with other care providers; resolving issues that could affect smooth care progression; fostering peer support; providing education to others regarding the case management process. The Case Manager will provide advocacy, information and referral services to patients and families to address their medical and psychosocial needs. This person is also responsible for gathering and reporting daily and weekly patient statistics required by management.

ESSENTIAL FUNCTIONS

Duties and responsibilities may be added, deleted or changed at any time at the discretion of management, formally or informally either verbally or in writing. Essential functions include, but are not limited to the following:

Patient Care

• Provides wellness focus for whole population including referral coordination, scheduling, transportation and outcome tracking.
• Provides a bridge between local hospitals and Georgia Mountains Health, linking patients with community resources to facilitate referrals and respond to social service needs.
• Participates in meetings and workshops for the purpose of conveying and/or gathering information required to help sustain and improve the care coordination program.
• Prepares quarterly activity reports for the CEO for the purpose of providing written support, ensuring accuracy of information, developing recommendations and/or conveying information.
• Presents clear, concise written and verbal communications for the purpose of ensuring that functions are being completed adequately.
• Assist in coordination of care with pharmacies, insurance enrollment and community networking to connect clients/patients with essential resources. Ensure that information goes when and where it is needed, patients are tracked and data entered into systems for follow-up and reporting.
• Track and support patients when services are obtained outside the practice and ensure information is recorded in EHS.
• Identification of safety net providers and specialists will agree to see uninsured patients.
• Maintains professional and technical knowledge by attending educational workshops; reviewing professional publications; establishing personal networks; benchmarking state-of-the-art practices; participating in professional societies.
• Maintains patient care database by entering new information as it becomes available; verifying findings and reports; backing up data.
• Collaborate with the medical staff to develop, implement and carry out programs in chronic disease management for patients, with such problems as diabetes, asthma, congestive heart failure, hypertension and depression, based on chronic disease management model.
• Act as a back-up to other Case Managers and team members as needed.
• Evaluates outcomes of care with the interdisciplinary team by measuring intervention effectiveness with the team; implementing team recommendations.
• Participation in a team-based approach for patient care involving clinical and non-clinical staff (e.g. physicians, nurse practitioners, nurses, medical assistants, receptionists, etc) in daily huddles and interacting with patients; collectively working toward achieving stated objectives.
• Other duties as assigned.

Personnel

• Develops interdisciplinary care plan and other case management tools by participating in meetings; coordinating information and care requirements with other care providers; resolving issues that could affect smooth care progression; fostering peer support; providing education to others regarding the case management process.
• Receive constructive feedback including evaluation of productivity and practice attributes. Provides constructive feedback to peers during review process or in training and mentoring situations.
• Help orient new medical staff and assess their skills and expertise to serve patients and to perform required office tasks consistent with clinic policy and procedure.
• Performing as an active member of the medical team including participation in staff meetings and collaboratives as requested.
• Other duties as assigned.

HIPAA/Compliance

• Maintain and work to protect the dignity, privacy and confidentiality of all patients, their families, employees and volunteer information and access such information only on a need to know basis for business purposes.
• Comply with all regulations regarding corporate integrity and security obligations. Report all behavior and/or activity that are unethical, fraudulent, or unlawful.
• Assures utilization of Patients’ Bill of Rights, privacy and confidentiality are consistently applied in the Organization.
• Maintains strict patient confidentiality in compliance with the Health Insurance Portability and Accountability Act (HIPAA).
• Other duties as assigned.

General

• Sets an example as a medical professional by observing work start and stop times, arriving to work prepared to perform duties of position, giving adequate notice for absences and following operational and personnel policies and procedures.
• Works flexible or extended hours where necessary, plans and participates in a wide-range of company projects and events.
• Stays informed of organizational activities and promote mission and goals.
• Regularly check email, mail, voice mail and other forms of communication. Ensures that all requests for information are handled promptly and professionally.
• Maintain professional working relationships with all levels of staff, clients and the public.
• Contribute to the success of the organization by participating in quality improvement activities.
• Stays open-minded, embracing key elements of diverse perspectives, adapting strategies as needs, expectations or the organizational climate evolves.
• Maintains effective flow of information to ensure that problems can be responsibly solved and support is provided to staff in order that operations run smoothly without disruption of services.
• Willing to submit to an annual screen for tuberculosis.
• Must successfully pass a pre-employment drug and alcohol screening test.
• Must be willing to submit to background check and OIG Exclusion List clearance verification (monthly).
• Other duties as assigned.

MINIMUM QUALIFICATIONS (KNOWLEDGE, SKILLS, ABILITIES)

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education

• High school diploma required.
• Prior experience working as an LPN (preferred), or medical assistant.
• Sufficient education and experience to carry out duties of position.

Experience

• Minimum of two years as an LPN (preferred) or medical assistant preferred.
• Must be a self-starter with excellent interpersonal and communication skills with a talent for customer service.
• Must have strong customer support orientation (for internal/external customers), demonstrated professional demeanor and the ability to maintain confidential information.
• Must have strong skills in organization and planning, efficient with strong attention to detail, demonstrated ability to work independently and exercise sound judgment and problem solving.
• Proven ability to prioritize tasks, exercise sound judgment and demonstrate confidentiality in maintaining sensitive information.

Knowledge

• Knowledge of healthcare regulations and preventative measures (HIPAA confidentiality, infection spread, etc).
• Working knowledge of medical office practices, managed care operation patient registration, reimbursement and personnel management. (Experience may be considered in lieu of education).
• Absolute integrity and sufficient maturity to handle the confidential aspects of the work.
• Ability to recognize the needs and concerns of people and maintain constructive working relationships.

Skills

• Ability to handle high to moderate levels of stress on a daily basis, demonstrating good judgment, common sense, understanding, problem solving, critical thinking and decision-making skills.
• Must be resourceful, an independent critical thinker, self-sufficient as well as self-motivated.
• Excellent computer skills including all MS Office applications (Word, Excel, Outlook, PowerPoint) and EMR required.
• Ability to operate standard office equipment including, but not limited to computers, printers, copiers, scanners, calculators, facsimile machines and multi-line telephone systems.
• Ability to apply common sense understanding and sound judgment to carry out and give instructions either written or oral.
• Ability to demonstrate capability to work under pressure, in a fast-paced environment.
• Ability to implement and enforce written plans, systems policies and objectives and effectively time manage.

Interpersonal and Communication Abilities

• Ability to use the Organization’s formal and informal social, political and technical structures to build relationships, negotiate solutions and accomplish goals.
• Excellent oral, auditory and written communication, interpersonal and presentation skills.
• Ability to interact effectively and professionally with diverse groups and demonstrate cultural awareness and sensitivity with a caring, respectful attitude with persons from diverse ages, genders, abilities, ethnicities, cultural, socioeconomic, educational, and professional backgrounds.
• Ability to interact effectively and professionally
• Ability to read, analyze and interpret general medical information.
• Ability to handle outside requests and inquiries calmly, adequately and in a manner that will preserve good public relations.
• Bilingual (English/Spanish) verbal and written skills highly desired.

Physical Abilities

• Must be able to reach above the shoulder level, bend, squat, sit, stand, stoop, crouch, reach, kneel, twist, turn, look around, fingering and feeling objects and equipment.
• Must be able to hear patients/staff on the phone and those who are served in-person, and speak clearly in order to communicate information to clients and staff.
• Must be able to have vision that is adequate to read memos, computer screens, forms and other clinical documents
• Must have high manual dexterity and demonstrate accurate control precision using selective equipment.

Transportation

• Valid Georgia driver’s license (or state of residence) and proof of personal driver’s insurance required.
• Ability to utilize own transportation for work purposes.
• Willing to travel to all Organization facilities or event sites as needed, attends and actively participates in all meetings and other activities as required or assigned.

Certificates, Licenses, Registrations

• N/A

PHYSICAL DEMANDS AND WORK ENVIRONMENT

The physical demands and work environment described here are representative of those that must be met by an employee to successfully perform the essential functions of this position. Reasonable accommodations may be made to enable individuals with disabilities to perform the functions unless to do so would impose a hardship on the Organization.

• Position may be located in a busy, crowded office area or clinic setting with noise at a moderate level.
• Position may work in an environment that is subject to the hazards of those environments including exposure to communicable diseases, blood, bodily fluids, infectious materials, chemicals and disinfectants.
• Position may be faced with interruptions and meeting with others on a regular basis.
• While performing the duties of the job, the employee may be required to commute to work or travel between work locations or event sites and be exposed to weather conditions prevalent at the time.
• Required eye-hand coordination and manual dexterity to sufficiently operate a computer keyboard, phone, printer, fax, calculator and other office equipment.
• While performing the duties of this position, the employee is regularly required to talk or hear.
• Specific vision abilities required by this position include close vision, distance vision, color vision, peripheral vision and the ability to adjust focus.
• The employee is frequently required to use hands; fingers; handle or feel objects, tools and controls; look down, left and right; reach with hands and arms; stand; walk; stoop; kneel; climb; balance; crouch or crawl.
• Position may require spending long hours sitting, using office equipment and computers or may require standing on your feet for several hours at a time.
• The employee must occasionally lift and/or move up to 25 pounds.

NOTE

This job description in no way states or implies that these are the only duties to be performed by the employee(s) incumbent in this position. Employees will be required to follow any other job-related instructions and to perform any other job-related duties requested by any person authorized to give instructions or assignments.

All duties and responsibilities are essential functions and requirements and are subject to possible modification to reasonably accommodate individuals with disabilities. To perform this job successfully, the incumbents will possess the skills aptitudes and abilities to perform each duty proficiently. Some requirements may exclude individuals who pose a direct threat or significant risk to the health or safety of themselves or others. The requirements listed in this document are the minimum levels of knowledge, skills or abilities.