Prestonsburg, Kentucky3 days ago
Key Responsibilities Care Coordination Assess client needs and develop individualized service or discharge plans Collaborate with interdisciplinary teams (physicians, nurses, social workers, therapists) Facilitate continuity of care across settings Outcomes Management Track and analyze patient/client outcomes and performance metrics Identify trends and opportunities for improvement Ensure services align with evidence-based practices and organizational goals Data Collection & Reporting Maintain accurate documentation in case management systems Collect data for quality improvement and regulatory compliance Prepare reports on outcomes, utilization, and performance indicators Utilization Review & Resource Management Evaluate appropriateness of services and resource use Support cost-effective care while maintaining quality Monitor length of stay, readmissions, and service utilization Patient/Client Advocacy Serve as a liaison between clients, families, and care teams Educate clients on treatment plans, resources, and services Address barriers to achieving desired outcomes Compliance & Quality Improvement Ensure compliance with federal, state, and organizational policies Participate in quality improvement initiatives Support accreditation and audit processes Qualifications Bachelor’s degree in Nursing, Social Work, Healthcare Administration, or related field (Master’s preferred for some organizations) Current licensure/certification (e.g., RN, LCSW, CCM, ACM) as required 2–5 years of case management, utilization review, or clinical experience Knowledge of healthcare systems, regulations, and payer guidelines Skills and Competencies Strong analytical and critical thinking skills Excellent communication and interpersonal abilities Proficiency in data analysis and reporting tools Ability to manage multiple cases and priorities Knowledge of quality metrics and outcomes measurement Problem-solving and decision-making skills Work Environment Hospitals, healthcare systems, insurance organizations, or community agencies May involve office-based work with some patient/client interaction Often requires collaboration across departments Performance Metrics May Include Readmission rates Length of stay Patient/client satisfaction scores Cost of care per case Compliance and audit results Responsibilities: Manages an assigned caseload of patients from preadmission to discharge. Assures payment for services rendered, coordinates care, manages resources, and facilitates each patient encounter for efficient and effective outcomes as related to quality, clinical and cost areas.