LPN/RN Case Manager

The Case Manager is responsible for the coordination of the RAI process in accordance with the OBRA and PPS regulations. Case Manager is responsible for the analysis of the Case Mix Index and the facility utilization management reviews.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

Complete clinical review updates with HMO insurance case managers for continued part A stay authorization approval.

Complete HMO skilled authorization requests for skilled level of care stays

Track and maintain compliance with Medicare certifications.

Complete entry and CTB trackers

Issue notices of noncoverage (NOMNCs) as required by state and federal regulations

Send appeal records to the Livanta QIO as required

Complete MDS’s per state and federal regulations

Work as part of an interdisciplinary team for discharge planning.

Assist the director of clinical reimbursement with MDS schedule and other duties as assigned.

Knowledge of the RAI process and longterm care experience helpful but not required, will train. Great opportunity for LPN or RN who wants to grow professionally.

Salaried position Monday through Friday. 

Work hours our 8am to 4:30pm

This position will require some unit coverage over weekends and/or holidays.