Career Information: Medical Case Manager

Reports to: Case Management Director
Department: Medical Case Management
Division: Case Management

JOB SUMMARY:
Aurora Case Management's definition of nurse case manager is consistent with the expectations of the Commission for Case Managers certification. Specifically, the nurse case manager helps the "…process directed at coordinating resources and creating flexible, cost effective options for catastrophically or chronically ill or injured individuals on a case by case basis to facilitate quality, individualized treatment goals. The case manager should facilitate communication and coordination between all members of the health care team involving the patient and family in the decision making process in order to minimize fragmentation of the health care delivery system."

Further, "The case manager educates the patient and all members of the health care delivery team about case management, community resources, insurance benefits, cost factors and issues in all related topics so that informed decisions may be made. The case manager is the link between the individual, the providers, the payers and the community. The case manager should encourage appropriate use of medical facilities and services, improve quality of care, and maintain cost effectiveness on a case-by-case basis. The case manager is an advocate for the patient as well as the payer to facilitate a win-win situation for the patient, the health care team and the payer."

ESSENTIAL FUNCTIONS:

1. Interviews candidates for case management services.
2. Telephones ahead to appropriate contact at the job service or employer to discuss job openings.
3. Tries to obtain an appointment date and time for the candidate.
4. Formulates job analyses/descriptions to be presented to physician and/or rehabilitation team for approval.
5. Prepares and dictates written evaluation and progress reports and case-recording documents.
6. Assists individuals in gaining insight into their roles in establishing vocational plans.
7. Participates in hospital, patient evaluations and team meetings.
8. Coordinates referrals to community resources and performs follow-up service.
9. Travels to metropolitan Baltimore/Washington DC area.

ADDITIONAL RESPONSIBILITIES:
Completes other related duties as assigned by department director.

KNOWLEDGE, SKILLS, AND ABILITIES:

1. Demonstrable effective oral and written communication skills.
2. Ability to work with various rehabilitation providers.
3. Ability to organize and implement individualized evaluations.
4. Must be qualified to be certified by the Maryland Workers' Compensation Commission and registered with the Maryland Board of Nursing.
5. Ability to work independently and organize time effectively.
6. Organizational ability to develop database of physicians and rehabilitation providers.

EDUCATION AND EXPERIENCE:

1. Licensure in registered nursing (Maryland)
2. Five years of work experience in the field of nursing