Job Posting for Case Manager (RN/LVN) at Community Care Center
Reports to: Administrator
Department: Nursing
Job Functions:
Summary
The primary purpose of this job position is to coordinate delivery of services to managed care and Medicare residents in collaboration with the facility’s team members. Responsible for facilitating interdisciplinary plans and assuring progress reports are completed and provided to payor as required; Also serves as liaison between patient, physician, care team members, payor, and the discharge planner by coordinating, monitoring, and communicating patient’s progress and cost evaluation and assisting with coordination to the next level of care. The Case Manager monitors and documents the cost effectiveness of treatment provided, facilitates and coordinates the admission and discharge process, serves as the resident and family advocate and acts as a liaison to insurance and medical management professionals.
Specific duties include, but are not limited to
Negotiates appropriate level of care within contract terms with the payor case manager; Utilizes “Out of Contract Pricing Worksheet” for non-contracted arrangements.
Communicates information to care team and coordinates patient's smooth transition to the next level of care.
Obtains accurate information from physicians, patient, and payor source regarding the expected discharge plan and communicates this information to the interdisciplinary team
Develops referrals from hospitals' social service and discharge planning departments, physicians, case managers, insurance companies and other referral sources
Participates in Marketing Action Plan and Key Account Meetings and assumes Key Account Management responsibilities as directed by their supervisor.
Coordinate and provide care that is safe, timely, effective, efficient, equitable, and client-centered
Handle case assignments, review case progress and determine case closure
Help clients achieve wellness and autonomy
Facilitate multiple care aspects (case coordination, information sharing, etc)
Help patients make informed decisions by acting as their advocate regarding their clinical status and treatment options
Develop effective working relations and cooperate with medical team throughout the entire case management process
Take the extra mile and interact with patients to keep track of their progress and to ensure satisfaction
Record cases information, complete accurately all necessary forms
Help with staffing if necessary
Ensure that daily skilled documentation is in place for skilled patients.
Works collaboratively with Rehab, MDS Coordinator, Business Office, Admissions, ADONs and DONs.
Conduct PPS/Skilled Kaiser Meetings as scheduled.
Prepares and updates MCR/ Skilled Tracking Sheet
Knowledge/Skills/Abilities
Proven working experience in case management
Excellent knowledge of case management principles, healthcare management and reimbursement
Previous experience working in skilled nursing facility
Effective communication skills
Excellent organizational and time management skills
Problem solving skills and ability to multi-task
Compassionate with teamwork skills
Comprehensive knowledge of managed care.
Familiarity with long- term care and/or sub-acute care useful. Strong oral, written, and organizational communication skills required.
Qualifications
Must be a graduate of an accredited school of nursing; BSN degree preferred.
Valid LVN license in the state of California
BS degree in related healthcare field
2 years of medical, clinical, concurrent review or pre-certification case management experience is preferred.
Salary.com Estimation for Case Manager (RN/LVN) in La Mesa, CA
$75,914 to $96,790
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