Case Manager - Inpatient Rehabilitation Center

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Screens/evaluates referrals for admission to determine eligibility. Secures physician approval for admission. Verifies insurance coverage information and obtains pre-authorization if insurance requires. Once patient admitted to the IRC, coordinates discharge planning needs and provides supportive counseling, and interventions for designated patient populations. Coordinates a variety of services such as intervention, client advocacy, education, and psychosocial assessments. Maintains utilization review process.

Job Duties

• Partners with unit-based care managers to ensure appropriate exchange of information regarding patient financial status, diagnosis, and discharge needs.
• Completes clinical review and assesses the appropriateness of admission through the evaluation of admission criteria.
• Conducts and documents detailed psycho-social assessments/evaluations to interpret social, environmental and medical needs of the patient and family.
• Intervenes and communicates with appropriate individuals (physician team members and insurance companies) to ensure appropriate utilization of resources, quality of care and care facilitation.
• Documents authorizations and continued stay reviews according to departmental policy and procedure.
• Provides timely, accurate, and thorough clinical reviews to assist in admission and continued stay reviews.
• Participates in Team Conference to support the patient, family for optimum plan of care. Facilitates discussion regarding plan of care with patient, family and third party insurance.
• Participates in the Performance Improvement process including assessment, implementation, and evaluation of new/updated processes to ensure goals are met each FY, as well as all procedures are streamlined for effectiveness and efficiency.

• Master's Degree in Social Work
• 2 years of previous utilization review experience. and
• 2 years Knowledge of utilization management as it relates to third party payers. and
• 2 years Case Management experience
• Ability to maintain the strictest adherence to HIPAA while maintaining confidentiality of all PHI.
• Ability to work in a team environment demonstrating flexibility to work toward common goals based around prioritized needs.
• Ability to be attentive to detail and maintain a positive attitude.
• Ability to complete work assignments accurately and in a timely manner while managing multiple responsibilities and prioritizing all tasks effectively.
• Demonstrates proficiency with all work queue processes.
• Knowledge of evidence-based clinical decision support criteria.

• Master's Degree in Social Work
• Knowledge of evidence-based criteria such as InterQual criteria and/or MCG criteria.
• ACM - Accredited Case Manager ACMA - State of Pennsylvania Upon Hire and
• CCM - Certified Case Manager CCMC - State of Pennsylvania Upon Hire and
• CMCN - Certified Managed Care Nurse ABMCN - State of Pennsylvania Upon Hire

Lift and carry 7 lbs., continuous sitting >67%, frequent keyboard use/repetitive motion, frequent fine motor activity/wrist position deviation.

Job Description Disclaimer: This position description provides the major duties/responsibilities, requirements and working conditions for the position. It is intended to be an accurate reflection of the current position, however management reserves the right to revise or change as necessary to meet organizational needs. Other responsibilities may be assigned when circumstances require.

Lehigh Valley Health Network is an equal opportunity employer. In accordance with, and where applicable, in addition to federal, state and local employment regulations, Lehigh Valley Health Network will provide employment opportunities to all persons without regard to race, color, religion, sex, age, national origin, sexual orientation, gender identity, disability or other such protected classes as may be defined by law. All personnel actions and programs will adhere to this policy. Personnel actions and programs include, but are not limited to recruitment, selection, hiring, transfers, promotions, terminations, compensation, benefits, educational programs and/or social activities.

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