The Case Manager, under the direction of the Supervisor will be a team player, expected to work in a collaborative fashion with internal as well as external customers. The Case Manager will adhere to the mission and values of this facility, and will be aware of cost containment opportunities. The Case Manager will strive to facilitate customized care according to the patient's needs and values across the continuum of care. The Case Manager will be self -directed and accountable for their work hours. The Case Manager will provide utilization review activities such as concurrent review of assigned patients including Medicare, Medicaid, commercial payor, HMO, and self -pay patient categories. Initial review for justification of acute hospital stay will be performed. In select instances precertification of insurance benefits may be required. The Case Manager will coordinate discharge plans for patients requiring post hospital services, such as nursing home placement, long term acute care, swing bed or other acute care or home health care services. He/she will be able to arrange for transportation, durable medical equipment, respiratory care and other services. The Case Manager will be well versed in medical terminology, Interqual Criteria, and MCG Criteria for evaluation of intensity of service and severity of illness. He/she will have working knowledge of DRG/ICD-CM coding reference books. The Case Manager will demonstrate the ability to independently abstract the patient chart and recognize pertinent clinical findings. Documentation will be timely and all handwritten notes will be legible. The Case Manager will be adaptable in performing work duties to meet the changing needs of the department. The Case Manager will have proficient knowledge of computers and programs such as: Word, Excel, Paragon, Allscripts Care Management, ECIN and/or any other computer programs used in Case Management. In addition, he/she will be familiar with use of fax and copy machine. The Case Manager will have accomplished verbal and written skills in order to interact with physicians, healthcare providers, patients, family members and others to facilitate appropriate quality patient services reviews. The Case Manager must be able to work and relate in a professional, non-defensive manner with peers, physicians, administration, patients and visitors. The Case Manager will be self-motivated to attend in-services, read professional journals, and search web site to maintain current knowledge of case management, utilization review and other education topics. Additional Job Skills: Review and analyze all admissions for severity of illness and intensity of service in order to obtain authorization for hospital confinement, if required. Performs an initial review of patients to ascertain discharge needs and requirements prior to discharge date, if needed. 3. Performs an initial review of admits in order to assign a working DRG for monitoring L.O.S. 4. Evaluates each assigned patient admitted to hospital within 24-48 hours to initiate a discharge plan. 5. Assist Supervisor to formulate, plan, write and provide departmental policies and procedures. 6. Assist Supervisor to develop departmental instruments for monitoring evaluation program. 7. Help monitor, evaluate P.I. for departmental aspects of care. Maintain close liaison with physician and other medical and non-medical staff. Learn and utilize Case Management Software (Allscripts & ECIN), Paragon, and all other hospital computer software/applications needed to perform job. Provide direct services, monitor, and evaluate services to: patients requiring financial assistance patients requiring nursing home/home health or referrals to other agencies as needed. 11. Perform other related duties as assigned by Supervisor of Case Management. Additional Knowledge Specified knowledge of community resources. Demonstrates knowledge of interdepartmental functions. Illustrates knowledge of computer and office machin ry functions. Demonstrates knowledge of government rules and regulations regarding reimbursement from federal and state agencies. Demonstrates knowledge & use of MCG Criteria and electronic InterQual criteria (Specified Criteria for Certification purposes). Demonstrates knowledge of DRG, ICD-CM, APR coding system used by Medicare for reimbursement by specific diagnosis.