WHAT DOES A CLINICAL CASE MANAGER DO?
Updated: Nov 21, 2024 - The Clinical Case Manager brings extensive case management experience, ideally with homeless populations, and a profound commitment to addressing the challenges faced by families affected by violence and homelessness. Expertise includes professional health and human services settings, with a strong grasp of local health and social services care coordination, including eligibility assistance. Additionally, the role demands excellent interpersonal communication skills, with a preference for candidates possessing knowledge in HIV direct care and Utilization Review.
A Review of Professional Skills and Functions for Clinical Case Manager
1. Clinical Case Manager Duties
- Veterans Care Coordination: Coordinate care through the Department of Veterans Affairs for Veterans, including liaising with GPs as needed on documentation.
- Eligibility Determination: Determine eligibility for other externally funded care services.
- Healthcare Liaison: Liaise with the resident’s general practitioner and other health care service providers.
- Comprehensive Assessment: Conduct or oversee comprehensive assessment of resident’s care and service needs following entry.
- Focused Assessment: Conduct focal assessments as indicated.
- Allied Health Coordination: Arrange for assessment by allied health professionals.
- Legal Documentation Handling: Obtain Enduring Power of Attorney documentation and liaise with legal representatives.
- Care Management: Liaise with the Village Care Manager to ensure residents receive the care and service they require to meet identified goals, needs, and preferences.
- Feedback Integration: Ensure feedback from the care team is used to update care plans and run sheets.
- Care Monitoring: Monitor the care team to ensure that care is delivered in accordance with run sheets.
2. Clinical Case Manager Details
- Documentation Skills: Ensure variances to planned care are documented, monitored, and that the care plan is updated accordingly and agreed to by the resident (or representative).
- Care Monitoring: Monitor unplanned care to determine whether the care plan requires changes.
- Clinical Review: Conduct ongoing clinical review and case management of all care recipients at scheduled intervals.
- Direct Care Provision: Provide direct resident care as directed by the Village Care Manager.
- On-Call Support: Provide on-call support to the shift RNs, when rostered.
- Relationship Management: Maintain effective and harmonious relationships with residents, families, and representatives.
- Professional Liaison: Liaise with doctors and allied health providers.
- Network Establishment: Establish an effective network of health and community services and providers.
- Cost Management: Ensure a timely and cost-effective manner in obtaining optimum value for both the client and the reimbursement source.
- Care Level Assessment: Assist in identifying the appropriate level of care, appropriate providers, and facilities.
3. Clinical Case Manager Responsibilities
- Clinical Expertise: Serves as expert Clinical co-manager on behavioral health claims from day 1 of STD claims and provides activities requiring clinical expertise.
- Provider Interaction: Perform provider interviews and analyze clinical information submitted.
- Negotiation Skills: Negotiate return to work plans with employee, treating provider, and employer if applicable.
- Investigative Skills: Investigate and resolve inconsistencies in the level of cognitive, emotional, or behavioral functioning depicted in clinical information submitted.
- Strategy Coordination: Coordinate a strategy to determine the true level of functional capacity utilizing direct contact with the treating provider and/or utilizing internal clinical resources (e.g., Peer-to-Peer Reviews, internal impairment guides, round table reviews, etc.).
- Consultation: Acts as a behavioral health consultant to the Appeals Unit.
- Resource Provision: Act as a resource to Operation staff when handling claimants noted to be threatening harm to themselves or others.
- Referral Facilitation: Facilitate referrals to collateral internal and external services, e.g., EAP, disease management programs, Advocacy, care managers, etc., as applicable.
- Quality Monitoring: Coordinate and monitor the quality of behavioral health IME's as applicable.
- Barrier Identification: Identify barriers for employees to return to work as well as identifying and prompting optimal health care to facilitate an appropriate and timely return-to-work.
4. Clinical Case Manager Accountabilities
- Clinical Practice: Provides quality clinical care through evidence-based practices with adults.
- Treatment Planning: Develop short-term treatment plans and coordinate discharge plans.
- Advocacy: Act as an advocate for the needs and interests of the patient and family/support system by supporting self-determination and autonomy.
- Collaborative Care: Create strength-based, collaborative care planning with the patient and family/support systems.
- Communication Skills: Provide clear and concise communication through consultation, education, facilitation, and team organization to patients and family/support system.
- Legal Liaison: Communicate with legal systems, schools, and social service agencies and provide court testimony.
- Healthcare Management: Assess, plan, implement, monitor, and evaluate options and services required to meet an individual’s health needs.
- Resource Utilization: Utilize a collaborative process and use communication and available resources to promote quality, cost-effective outcomes.
- Return-to-Work Planning: Strategize with claimants, treating providers, and employers on possible accommodations or restrictions to facilitate transitional return-to-work plans.
5. Clinical Case Manager Functions
- Collaboration: Work closely with volunteer house parents in a transitional housing program, foster families, and Outreach staff
- Support Services: Provide supportive housing to young adults and help launch them into independent, productive lives.
- Case Management: Case management with each resident to assess, plan, and implement changes needed for future success and independent living.
- Community Engagement: Maintain and develop relationships with foster host homes within the community to offer more housing options for homeless young adults.
- Youth Support: Work with at-risk homeless youth and young adults in the community
- Assistance Provision: Assist with basic needs and steps toward a more secure future.
- Regulatory Compliance: Ensure compliance with DCFS licensing standards and grant requirements.
- Team Participation: Reports to the Director of Wheaton Youth Outreach and participates as a member of the broader transitional housing and Wheaton Youth Outreach staff teams.
- Compliance Reporting: Reporting non-compliance to the Court and conduct psycho-social assessments
- Treatment Follow-up: Monitor clients’ compliance with treatment as indicated by follow-ups with clients at home and with community providers.
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