Facilities for the mentally disabled have case managers who are responsible for coordinating the care and treatment of each patient. These case managers are trained and licensed social workers with experience working with the mentally disabled. The caseload for a case manager varies based on the size of the facility and the amount of case managers on staff in the facility.
The case worker is responsible for the management and coordination of care for their clients. They do not provide direct therapeutic services; rather, they are responsible for evaluating the needs of each individual client on an ongoing basis and ensuring the client is functional with the least invasive treatments. Once they've determined the interventions for each client, they make the appropriate referrals and follow up with other care providers. They are also responsible for maintaining accurate records for each client.
When meeting with the client, the case manager creates a service plan and determines if he is eligible for specialized services, such as occupational therapy. The case manager also seeks non-health resources the client might be eligible for, such as financial or nutritional assistance from government programs. The case manager assists the client in applying for services, and follows the application process until the client is approved or rejected. He also coordinates care between any care providers, including doctors, nurses, and therapists.
Medical Necessity and Referrals
Medicaid, Medicare and health insurance companies require that all treatments are a matter of medical necessity or they do not authorize payment. It is the case manager's responsibility to evaluate the client for the medical necessity of each recommended service and then document the proof of medical necessity for the relevant paying company. Referrals to outside providers also require proof of their medical necessity.
Case managers are responsible for the documentation of all aspects of their caseload. This includes accurate and updated files on all clients, as well as records of all services requested for the client and the current status of those requests. They may also be responsible for providing billing information to insurance companies. Some case managers are also responsible for creating and maintaining budgets for their facilities. Case managers work regular hours in the facility.
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