Case Manager
JOB DESCRIPTION SUMMARY
Responsible for direct and indirect support services to patients to help access services, engage
and maintain medical care, and achieve positive outcomes. Case Managers can also promote the
empowerment of patients, and assist with care management activities.
ESSENTIAL JOB FUNCTIONS
1. Performs duties consistent with the Vocational Nursing Practice Act.
2. Coordinates home care services for home health patients, assists with the establishment
of the plan of care in coordination with the physician, insurance, Clinical Managers and ensures
a seamless transition to home health care.
3. Verifies insurance coverage and obtains initial authorizations for services and seeks
reauthorization for ongoing and additional services.
4. Works with Clinical Managers and clinicians to gather, collate, and report patient care
summary information to Primary Care Physicians.
5. Maintains comprehensive working knowledge of contractual relationships
and ensures that patients are admitted and services are delivered in accordance with
contract provisions.
6. Establishes and maintains positive working relationships with current and potential
patients and caregivers.
7. Promptly responds to patient’s requests and concerns.
8. Assists in building community, customer, payer and patient perceptions of MIRACLE
HOME HEALTH CARE INC. as a high quality provider of services.
9. Maintains comprehensive working knowledge in the field of home health and shares
information with appropriate agency personnel.
10. Maintains comprehensive working knowledge of community resources and assists
customers in accessing community resources should services not be provided by MIRACLE
HOME HEALTHCARE INC.
11. Participate in monthly Miracle Home Health Inc. In-Services
12. Performs daily the QA of (30) thirty patient specific nursing skilled visits notes (eligibility
days excluded)
13.Responsible for maintaining the accurate health insurance of all patients by checking and
updating patient medical eligibility via Med-Cal / LA CARE portal and Medicare.
The above statements are intended to be a representative summary of the major duties and
responsibilities performed by incumbents of this job. The incumbents may be requested to
perform job-related tasks other than those stated in this description.
ESSENTIAL DAILY RESPONSIBILITIES
1. PEN - WORK ON "PEN" EVERY MORNING. GO TO SEARCH AND TYPE "PEN"
2. CALL YOUR PATIENT INTRODUCE YOURSELF - CONFIRM ADDRESS, COVID SCREENING, ASK IF PATIENT IF HE/SHE GOT THE FLU SHOT AND COVID VACCINE.
3. CONFIRM PCP. IF INITIAL AUTHORIZATION IS STILL PENDING, CALL HEALTH PLAN TO FOLLOW UP TO CONFIRM IF THE AUTHORIZATION WAS RECEIVED AND/OR IF STILL PENDING. DO NOT FORGET TO ASK FOR THE NAME OF THE PERSON YOU SPOKE TO AND ASK THE REFERENCE NUMBER OR PENDING AUTH NUMBER
4. CREATE COMMUNICATIONS - AS MUCH AS POSSIBLE ALWAYS ASK WHO YOU SPOKE WITH, INCLUDE REAL TIME TO YOUR NOTES. SIGN AND COMPLETE.
5. PLOT DISCIPLINES - SCHEDULE ACTIVITY SCHEDULE MANAGER - SCHEDULE EMPLOYEE
6. FOLLOW UP ON PT/OT/ST/MSW EVAL IF EVALUATION IS STILL NOT COMPLETED WITHIN 24-48 HOURS FROM THE DATE PLOTTED
7. EDIT PHYSICIANS ADDRESS AND/OR FAX NUMBER - VIEW - LIST – PHYSICIANS
8. SEARCH FOR EMPLOYEE CONTACTS - VIEW - LIST – USERS
9. CALL YOUR PATIENTS ONCE A WEEK FOR FOLLOW - UP CALLS TO ESTABLISH A RELATIONSHIP WITH YOUR PATIENT - ASK HOW ARE YOU DOING? HOW ARE THE NURSE/PT/OT/ST/HHA/MSW VISITS? IS THERE ANYTHING YOU NEED? DO YOU STILL HAVE SUPPLIES? ARE YOU TAKING THEIR MEDICATIONS? WHEN IS YOUR NEXT PCP APPT? DO YOU HAVE ANY QUESTIONS?
10. ASSIGN NURSES BASED ON THE AREA THEY COVER - USE THE MAP TO GUIDE YOU
11. FAX ORDERS IF ORDERS ARE STILL NOT "RETURNED W/PHYSICIAN SIGNATURE" CREATE FAX COVERS, ATTACH ALL UNSIGNED ORDERS THEN CLICK SEND. ATTACH THE ONCE IT HAS BEEN SUCCESSFULLY SENT. CALL PCP OFFICE TO CONFIRM IF THEY RECEIVED THE FAX YOU JUST SENT TO BE SENT TO PHYSICIAN - FAX ORDERS
a. SENT TO PHYSICIAN (ELECTRONICALLY) - FAX ORDERS
b. SUBMITTED (PENDING QA REVIEW) - DO NOT FAX YET
c. RETURNED W/PHYSICIAN SIGNATURE - DO NOT NEED TO FAX IT WAS SIGNED AND FAXED BY THE PHYSICIAN ALREADY
12. YOU MUST SUBMIT YOUR N/A BY THE END OF THE DAY OR AS SOON AS YOU RECEIVE THE N/A LIST VIA TEXT TO HAZEL AND/OR IN YOUR ASSIGNED GROUP THREAD BASE ON YOUR ASSIGNED LETTER(S)
13. MANDATORY - CALL 2 PATIENTS EVERY THURSDAY FOR "CUSTOMER SERVICE
a PHONE SURVEY" CREATE A COMMUNICATION NOTE COMMUNICATION TEXT "SELECT TEMPLATE", SELECT "CUSTOMER SERVICE PHONE SURVEY - MHHCI" ANSWER QUESTIONS: YES, NO OR N/A. COMPLETE YOUR COMMUNICATION NOTE.
14. EVERY 1ST AND 15TH OF THE MONTH IS ELIGIBILITY DAY
15. CONFIRM EVV IS BEING DONE FOR ALL MEDICAID PATIENT VISITS
16. MEDICARE/MEDICARE HMO PATIENT ARE REQUIRED TO RECEIVE A NOMNC AT LEAST 2 DAYS BEFORE DISCHARGING
ESSENTIAL WEEKLY TASKS
- MONDAY: Catheter Rounds / No Activity (NA) Report
- TUESDAY: (5) Days & Above / No Activity (NA) Report
- WEDNESDAY: Physician Orders / No Activity (NA) Report
- THURSDAY: (2) Courtesy Calls / Physician Orders / No Activity (NA) Report
- FRIDAY: (10) Days & Above / Physician Orders / No Activity (NA) Report