Case Manager - RN

Genesis HealthCare is one of the leading providers of healthcare services from short-term to long-term care and a wide variety of living options and professional clinical services. We are changing how care is delivered by bringing together people like you -- passionate, highly skilled and motivated to make a difference.
Why Genesis? We improve the lives we touch through the delivery of high-quality healthcare and everyday compassion! *We Care Deeply about YOU! Guided by our Core Values, Code of Conduct and Ethics program, we foster a culture of care and compassion. We focus on improving the quality of care through creativity and innovation, honesty and integrity in all we do. *We Develop YOU! We provide career ladders, education and training opportunities so you can build a long and successful career with Genesis. *We Appreciate YOU! We value your contributions to the Genesis mission and vision and instill an environment of teamwork and enjoyment in working together. We recognize and celebrate our shared successes. *We are Committed to YOU! We know you are the vital link between Genesis, our patients and residents! We inspire you to be your best self. *We Protect YOU! We take great pride in meeting or exceeding CDC and CMS standards. The Case Manager ensures the collaborative process of assessment, planning, facilitation and advocacy for options and services to meet the patient's health needs with quality and cost-effective outcomes as the priorities.
Position Highlights *Monitor patients' case throughout stay to ensure utilization of services are in accordance with plan of care and minimize financial risk to patient and center. *Verify and communicate current, accurate and complete clinical information to payer from patient Pre-Admission through Concurrent Review using standard and plan review forms to justify clinical necessity according to payer review schedule. *Review Pre-Admission Review (PAR) and IRM Pre-Authorization assessment to identify costly treatments, supplies or services. *Communicate contract terms for patients' stay to Interdisciplinary Team and ensure the team implements services in the patient plan of care subject to contract terms and case negotiations in order to minimize overutilization or under-utilization of services and unreimbursed claims. *Negotiate for appropriate continuation of length of stay or extension of services and appropriate Level of Care (what is covered/what is not covered) and associated rates. *Obtain payer authorization for recommended treatments, procedures, supplies, equipment and medications and all exclusions.
Benefits *Health, Dental, Vision, Company-paid life insurance, 401K, Paid Time Off *Variable compensation plans *Inclusive workplace with DEI committee *Nursing Student Loan Debt Repayment and Tuition Assistance *Tuition, Travel, and Wireless Service Discounts *Employee Assistance Program to support mental health *Employee Foundation to financially assist through unforeseen hardships
Restrictions apply based on collective bargaining agreements, applicable state law and factors such as pay classification (full-time, part-time, or casual), job grade, location, and length of service.
SHAREMINC
Qualifications: *Graduate of an accredited School of Nursing with current RN licensure in the state where employment occurs or where case management is practiced contingent upon state regulations required. *Bachelor's Degree in Nursing, Certified Case Management (CCM) or related clinical certifications is preferred. *Five years of recent clinical nursing experience is required. *Prior experience in utilization review, case management or discharge planning is required. *Prior experience using evidence-based clinical decision support criteria (e.g. Interqual, Milliman) *Experience in rehabilitation nursing, acute care and/or the insurance field preferred. *Two years' full time experience in case management which includes service to short/long term facility based clients is preferred. *Must have advanced knowledge of third party reimbursement, insurance coverage and contract requirements. To protect the health and safety of our patients, residents, employees, family members, and the communities we serve, Genesis has implemented a universal COVID-19 vaccination requirement for employees, care partners and onsite vendors.
Position Type: Full Time
Requisition Number: 436449

Pay Target:
Bachelor's Preferred

Five-Plus Years