Role of the Case Manager in the LTACH

03 Feb Role of the Case Manager in the LTACH

Patricia Gaughran, R.N., B.S.N., M.A.By Patty Gaughran, RN, MA

Case Managers steward each patient through the entire stay from admission to discharge. In a sense, they are the logistics managers of patient care. These professionals are responsible for safely seeing each patient through their Long Term Acute Care Hospital (LTACH) stay.

A day in the life of the Case Manager at Specialty Hospital of Central Jersey can be hectic. The daily “to-do” list sometimes seems a mile long. However, patients and family members are always the priority. Countless phone calls and emails need to be returned. Planned and impromptu meetings take up a great deal of time.

Role of the Case Manager in the LTACH

Duties of a Case Manager

Everyday, new patients need LTACH placement. The first duty of a Case Manager is to review all available medical records to make sure patient needs can be met. Admission criteria are very specific. The Case Manager must verify each patient fits these parameters before granting acceptance. A determination is then made regarding appropriate placement. He or she consults with the physician when patients have complex conditions or are beyond the scope of care.

The Case Manager also verifies insurance coverage prior to admission. Every insurance policy is different, so the coverage is different. The patient and family must be made aware of any out-of-pocket expenses associated with the stay. I always share information regarding secondary insurance coverage, as patients do not realize how quickly their Medicare time can be depleted. The Medicare website explains the coverage and lists option for secondary choices. Visit https://www.medicare.gov or call 1-800-Medicare or 1-800-633-4227.

Conversely, updates are provided to the insurance company to secure additional coverage. Case Managers must always provide an accurate picture of the patient’s condition and status while trying to get approval for continued coverage.

Interdisciplinary Care plan meetings are formal meetings led by the Case Manager to discuss patient progress. They occur weekly. The care plan is a comprehensive guide designed to manage patient health and treatment on a daily basis. Discussions about medications and therapeutic treatments are common. Nursing aids may provide feedback on activities-of-daily-living. Physical therapists and occupational therapists could discuss assistive devices needed to foster independence. The plan is written and placed in the patient chart for all care providers to reference.

Families are eager to know how their loved one is progressing. It is comforting to have an attentive professional listening to concerns and providing answers to difficult questions. Case Managers act as a liaison between the care team and families and serve as a central point of contact.

Referrals for the Specialty Hospital of Central Jersey

If you need to refer someone for admission, the hospital Case Manager or social worker provides the documentation needed to evaluate the patient via fax. External Case Managers from the LTACH are available to meet with families to answer any questions or to retrieve the information needed to complete the referral process. 

Do You Have What It Takes?

Case Managers play a vital role in the LTACH. They manage the process that helps patients gain access to care and eventually return home. They ensure insurance coverage is available and payments are made on the patient’s behalf.

If you’re interested in becoming a Case Manager, exceptional organizational skills are needed to stay on task and meet every deadline. Accuracy and attention to detail are a vital part of the care plan process. Excellent communication skills are required to speak with patients, families and doctors, and each message must be tailored to fit its audience.

About LTACH

Long Term Acute Care Hospitals were created to serve a once underserved segment of the patient population.  This option allows patients who meet the criteria an extended period of time to recover to their highest functional level. LTACH’s provide comparable levels of care to traditional hospitals and at Specialty Hospital of Central Jersey care is delivered with a team approach achieving the patient’s’ goals over a longer course of time. Please contact us at Specialty Hospital of Central Jersey by calling 732.942.3592.  We are conveniently located at 600 River Avenue in Lakewood, New Jersey.

Patricia Gaughran, RN, MA has been a case manager for over 10 years with AcuteCare Health System working in the LTACH level of care.