The facility-based Case Manager and Clinical Social Worker interacts with the patient, family members, physicians, team members, and payers to enhance service and quality and to assist in the delivery of cost effective outcomes. The Case Manager assesses, plans, implements, and monitors the services and alternatives geared toward meeting an individual’s rehab health needs. This is accomplished through coordination of available resources and through communication to all involved parties regarding goals and progress.
During hospitalization, a common concern shared by patients and their families is, “Will my insurance cover this treatment?” The Case Manager functions as a liaison between the patient and their insurance carrier to assist in answering that question and to secure payment for needed services.
Case Management/Clinical Social Worker Services
Collaborates with Admissions Coordinators and Admissions Liaisons regarding pre-admission screening processes to assure a patient’s smooth transition to the appropriate level of rehabilitative care.
Facilitates effective and efficient team conferences and assists in keeping the patient and family informed regarding goals and progress. Also provides updates to payers for continued stay approval.
Assists with discharge planning including referral to other services as appropriate to facilitate community reentry.
The Case Manager/Clinical Social Worker is a healthcare professional who combines clinical knowledge of rehabilitation care with experience in insurance and reimbursement issues. They are available to assist patients, families, physicians, payers, and other team members with whatever issues they have concerning total patient care and reimbursement.