Case Manager Extender PRN as needed
Core
Facilitate transitions of care for patients before and after acute hospital episodes, focusing on medical, psychosocial, and economic concerns to decrease fragmentation and promote coordination of comprehensive services.
Role type
Case Manager Extender (adjunct to RN/SW case managers)
Builds
Post-acute care pathways and resource access for patients with chronic conditions and functional limitations
Domain
Healthcare / Hospital discharge planning and transitions of care
Deliverable
client delivery
Required skills
Resource brokering, system navigation, interdisciplinary collaboration, utilization review, disposition coding, community partnership development
Preferred skills
Healthcare industry knowledge, familiarity with government regulations (discharge planning, abuse, advanced directives), patient engagement training
Technologies
Computer systems for documentation and communication
Responsibilities
Assess and develop initial screens for non-complex planned admissions, facilitate access to services (SNF, home care, hospice, DME, transportation), reassess low-risk patients, act as point person for post-acute and physician practices, manage department resources, handle department communication
Seniority
Entry to Mid-level, supportive role under supervision
