Field Case Manager jobs in Waltham, MA

Works with the Interdisciplinary Group (IDG) to develop, coordinate, and update the individualized plan of care for hospice patients/families cooperatively with the patient and/or family, physician and hospice team.

Review all required items such as Unlisted Item Report (to coordinate adding unlisted allergies, meds, and/or supplies), Visit Note (for information regarding patient status), Medication Profile (to review contraindications), Calendar (to ensure proper disciplines, frequencies, and buddy codes), Problem Statements/Care Plans (to ensure proper 485/goals and pathways), OASIS Report (for HIPPS,HHRG and OASIS info), Coordination Notes (for idea of patient status), Aide Care Plan (for aide services), Supply Requisition, Initial Order (for review), Authorization Information Report (for non-Medicare patients), Case Mix Details and Insight Report (for insight into clinical, functional, and service areas), Medicare Utilization Summary (Episode Analysis Tool to manage financial viability, revenues, costs, and visit details), Therapy Report (to determine likelihood of need for therapy), HHCAHPS Survey Data (Home health survey data), etc.

Participate in pre-admission evaluation of supported persons in terms of health care services needs and the capacity of the facility to supply the needed services.

Attends case conferences as scheduled to discuss and evaluate patient diagnoses, treatment plans, progress, goals, scheduling, problems, and interventions with interdisciplinary team.

Completes Client Related Task of Review Evaluation Documentation which presents in workflow once the assessing clinician has completed the evaluation to ensure quality care, quality documentation, criteria met for patient to qualify for services and plan of care established to meet the needs of the patient.

Provides a positive work environment by consistently modeling in a positive way, the agency philosophy, mission, values, and standards of care, and providing a professional role model for other staff.

Requires frequent travel in his/her assigned area to meet with medical providers, attorneys, employers, and injured workers.

Enters timely and accurate data into designated case management applications as needed to communicate patient needs and maintains audit scores of 95% or greater on a monthly basis as well as to be determined patient satisfactory scores.