Integrated Case Manager

Core Job Duties

• Meet with assigned patients within established organizational timeframes, complete the required initial contact, and take ownership of the complete integrated case management workflow throughout the treatment episode.
• Complete required case management and discharge-needs assessments; identify financial, insurance, discharge, aftercare, employment, legal, and other barriers; develop an individualized Case Management Discharge Plan (CMDP); and review and update the CMDP at least weekly or sooner when patient needs change.
• Educate patients and responsible parties regarding insurance benefits, patient financial responsibility, billing expectations, and available payment options.
• Review and validate insurance coverage and patient financial responsibility using approved systems, payer portals, Revenue Cycle resources, and direct payer communication when necessary.
• Monitor coverage throughout treatment and address coverage changes, lapses, coordination-of-benefits issues, or financial barriers that may affect treatment or continuity of care.
• Collect applicable private-pay fees, copays, deductibles, and other patient responsibility and establish approved payment arrangements in accordance with organizational policy.
• Maintain accurate and timely financial documentation in Avatar, including CEFE information, guarantor order, collections, payments, payment arrangements, financial counseling, and patient or responsible party communication.
• Conduct ongoing discharge and aftercare planning; review the plan with the patient; coordinate direct warm handoffs; confirm follow-up appointments before discharge when applicable; obtain patient feedback; and document the final plan in Avatar.
• Collaborate with Business Development, referents, payors, outpatient services, and community providers and document required communication in approved systems, including Avatar and Salesforce, as applicable.
• Coordinate the administrative components of FMLA, short-term disability, state-paid leave, and return-to-work requests, including intake, tracking, patient communication, completion of non-medical sections, and timely routing.
• Coordinate medical certification and clinical documentation with the Patient Services Coordinator and appropriate provider and do not complete medical sections outside the scope of the position.
• Ensure aftercare plans, CMDP documentation, discharge folders, referrals, appointments, required letters, and patient resources are complete, accurate, and patient-ready.
• Participate in treatment team meetings and communicate relevant financial, discharge, aftercare, and patient-barrier information necessary to support treatment planning and continuity of care.
• Coordinate with fellow Integrated Case Managers regarding treatment-team attendance, patient intakes, workload distribution, coverage needs, daily huddles, and handoff processes to support efficient workflow and prevent missed responsibilities.
• Collaborate with Revenue Cycle Management, Admissions, Utilization Review, Clinical Leadership, and other departments to resolve financial, insurance, discharge, or continuity-of-care barriers.
• Meet established integrated performance expectations across initial patient contact, weekly CMDP follow-up, financial counseling and collections, leave-related requests, appointment coordination, warm handoffs, aftercare completion, and timely documentation; proactively addressing outstanding patient needs.
• Escalate significant financial, coverage, discharge, documentation, patient care, or workflow barriers to appropriate leadership when resolution falls outside the scope of the position.
• Maintain competency in all Integrated Case Management responsibilities through required education, cross-training, and ongoing professional development.

Other Required Tasks

• Develop and maintain proficiency in Heather AI and other approved documentation systems, ensuring accurate and timely entry into the electronic medical record.
• Support patient de-escalation using approved techniques and maintain appropriate professional boundaries.
• Communicate significant patient developments, risks, barriers, and operational concerns to the appropriate supervisor or treatment team member in a timely manner.
• Attend required treatment team, case management, operational, and individual check-in meetings.
• Accept and incorporate supervisory feedback and adapt to changing workflow, patient, and site needs.
• Track and support quality and performance expectations established by leadership.
• Maintain strict confidentiality and compliance with HIPAA, state, federal, accreditation, and organizational requirements.
• Perform other duties assigned to support patient care and organizational operations.