Reports to: Director of Nursing
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 RN /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.