Case Manager (Full Time)
Location: Wilmington
BASIC PURPOSE:
The Case Manager I is responsible for coordinating all facets of the patients stay and discharge plan in the Rehabilitation and Wellness Pavilion. The Coordinator will ensure that Guests/Patients are acclimated to and satisfied with Pavilion services by working across departmental lines to ensure seamless delivery and coordination of services for the duration of the Guest/Patient stay.
MAJOR WORK ACTIVITIES:
1. Welcome and Acclimate Guest to facilities with 24 hours. Facilitate all services across all departments throughout the stay.
2. Greets and escorts new residents and discharging residents to the Pavilion or assigned CND nursing unit or as needed at Champions.
3. Coordinate room assignment and arrival of admissions with Community Liaison.
4. Assist with Bed Control and room moves by coordinating with Community Liaison, Long term care units and other Case Manager.
5. Collaborate with interdisciplinary team to facilitate discharge planning and recommendations considering all aspects of the discharge process. Coordinate with IDT to ensure constant communication exchange of information at early team meeting.
6. Develop collaborative relationships with other departments, entities and external health care agencies to facilitate and support quality of care and discharge planning.
7. Contact outside resources for continuum care such as Home Health Agencies as well as DME companies to ensure a safe discharge to include wellness opportunities at The Davis Community.
8. Act as an educational resource for patients, families, and interdisciplinary team members.
9. Schedule and facilitate family meetings for potential discharge as well as updates of resident progress.
10. Direct daily operations of record processing to ensure that discharge records are properly received, organized and forwarded to the appropriate physician for completion.
11. Daily communication patient/family contact, maintaining communication with physicians, patient care providers, and other team members regarding treatment plans in order to ascertain appropriate level of care, coordinate timely delivery of services, assist staff in identifying and addressing the learning needs of patient and families and intervene as appropriate.
12. Obtain information from medical record, interdisciplinary team, family members and the clients to assess client's capabilities, needs and interests.
13. Complete scheduled MDS assessments in a timely and accurate manner and develop care plan to meet needs of client, based on needs assessment and client interest. Implement and follow through on care plan approaches. Document patient interactions, progress, and discharge plans in the patient medical record.
14. Monitor/Assess performance of clients, personal performance and systems to make improvements or take corrective action.
15. Perform 1:1 interaction and in- room visits to meet rehab needs and document outcome.
16. Communicate 3 day Care Plan Team meeting to guests and Care Plan Team.
17. Work with therapy and all disciplines to ensure all questions and needs are met to ensure customer satisfaction and good hospitality.
18. Cross trained in admission process for overflow on high volume days
19. Work collaboratively with the other case manager for coverage ensuring consistent communication and systems are utilized.
20. Communicates facility philosophy, offered services and amenities to potential and new residents and/or their representatives.
21. Acts as liaison between transferring institutions and the Center by maintaining a good rapport.
22. Conducts tours for prospective residents.
23. Attend required committee meetings and continuing education as appropriate.
24. Advocate for resident's rights, educate residents, their families and staff regarding the rights of residents outline under state/federal guidelines.
25. Demonstrate strong leadership and communication skills that are effective in working with a variety of persons, including patient, public, coworkers, guest, outside agencies and medical staff.
26. Support management/department during time of stress or change.
27. Perform other duties and responsibilities as assigned by Pavilion Director.
Knowledge, Skills and Working Conditions:
MINIMUM QUALIFICATIONS:
Education: High School Diploma required. Bachelor’s Degree or Associates Degree preferred.
Licensure/ Certification: None.
Experience: Two years of related health care/case management/discharge planning/social work or recreation experience.
An equivalent combination of education and experience may be considered.