Case Manager Skills Checklist | Health Hybrid Medical Staffing

Date:*

Name: (First, MI, Last)*

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Area

Collect and assess patient information pertinent to patient's history, condition, and functional abilities in order to develop a comprehensive, individualized care plan that promotes wellness, appropriate utilization, and cost-effective care and services.*

Develop, implement, and coordinate case management action plan for achieving specified patient goals as determined by the case management action plan. Coordinate necessary resources to achieve goals and objectives.*

Monitor and evaluate appropriateness of case management action plan, assess progress toward meeting goals, and modify the plan to help achieve desired patient outcomes.*

Support outreach activities as needed to members, clients, providers and others.*

Perform concurrent review of patients admitted to hospitals.*

Serve as a resource to assist patient and patient's family in accessing appropriate providers, facilities, and community resources for their behavioral healthcare needs.*

Review referral and preauthorization requests for appropriateness of care within contract guidelines.*

Identify high exposure cases, case management or utilization review issues, pertinent inquiries, problems and decisions that may require review.*

Identify and negotiate with appropriate vendors to provide services*

Serve as primary resource to patient and family members for questions and concerns related to the health plan and navigating through the health systems issues.*

Track and manage provider claims related to case load.*

Identify catastrophic or high exposure cases.*

Thorough knowledge and understanding of medical procedures, diagnoses, care modalities, and procedures codes.*

Thorough knowledge of community services, providers, vendors and facilities available to assist members.*

Ability to use computerized systems for data recording and retrieval*

Experience in case management, including cases that require rehabilitation treatment.*

Experience in case management, including cases that require home health treatment.*

Excellent communication and negotiation skills, both verbal and written.*

Experience in case management, including cases that require hospice treatment.

Basic math skills including percentages, ratios, graphing and spreadsheet skills.*

Making decisions for care outside contractual benefits that are mutually beneficial and cost-effective.*

BLS

ACLS

Telemetry Certificate

ONS Chemo/Biotherapy Certification

Other Chemo Certification

Areas of Expertise:

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