The Medical Case Manager usually answers to either the director of nursing or clinical care for the facility, or the CFO. Duties include but are not limited to interviewing or corresponding with physicians to correct errors or omissions and to investigate questionable claims; analyzing information gathered by investigation; reporting findings and recommendations; recommending process and policies to improve quality of patient services and increase revenue; and compiling, auditing and analyzing patient records to document conditions and treatments and to provide data for cost control and care improvement efforts.
The Medical Case Manager works independently with minimal supervision and may supervise clerical and/or medical records staff. This position requires excellent writing, mathematical, analytical and organizational skills, as well as the ability to multi-task, thrive in a busy and stressful environment, and maintain professionalism and confidentiality. A strong understanding of the business and financial aspects of medical care is required. The Medical Case Manager must be able to relate professionally to supervisors, coworkers, representatives of other organizations, and patients.
Proficiency in Microsoft Word and Excel is required, as well as familiarity with software generally used in medical settings. The Medical Case Manager must have a general understanding of medical coding.
The minimum qualification for this position is a BSN; experience in medical case management or utilization review is preferred. CCM is preferred; if not, must be eligible to obtain CCM within two years of hire. This is a salaried position with a normal Monday through Friday schedule.
Case Manager Tasks
- Recommend process and policies to improve quality of patient services and increase revenue.
- Analyze information gathered by investigation; report findings and recommendations.
- Interview or correspond with physicians to correct errors or omissions and to investigate questionable claims.
- Compile, audit and analyze patient records to document condition and treatment and to provide data for cost control and care improvement efforts.