Regional Case Manager (Remote)
Regional Case Manager (Remote)
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1 Vacancy
Job Description
Overview
Smile Youve Found Us!
Are you passionate about caregiving Would you like to work with the best team in the world If so Diversicare invites you to apply.
We build on trust respect customer focus compassion diplomacy appreciation and strong communication skills to shape the culture in our workplace. Diversicare team members play a critical role in fostering an environment of Service Excellence which we extend to all those we are privileged to serve.
Make a Difference in our Residents Lives!
Diversicare Healthcare Services is seeking an outstanding RN Case Manager that has a passion for providing the highest quality of care with compassion and integrity!
We live our Core Values of Integrity Excellence Compassion and Teamwork & Stewardship every day with every life we touch providing exceptional healthcare and exceeding expectations.
RN Case Manager
Our case managers are accountable for the care coordination and discharge planning of our patients. They provide ongoing support and expertise through comprehensive assessment planning implementation and overall evaluation of individual patient needs. The overall goal of the position is to enhance the quality of patient management and satisfaction promote continuity of care and cost effectiveness utilization review and management as well as discharge planning. Additionally this is a home-based and fully remote RN Case Manager position.
Responsibilities
Responsibilities
This position requires multi-tasking to ensure managed care authorizations are received at the highest level of reimbursement and as quickly as possible.
We communicate with the insurance case managers to obtain authorization for the correct level of care according to the patients needs under the reimbursement guidelines provided by patients benefits and current managed care contract.
We ensure the highest level of customer service to the managed care plan.
The case manager provides center case management/utilization review and discharge planning to assure that the patient progresses through the continuum of care and is discharged to the least restrictive environment.
Coordinate the integration of the social service function into patient care.
Coordinate the facility activities concerned with case management and discharge planning.
Adhere to departmental goals objectives standards of performance policies and procedures.
Ensure compliance with quality patient care and regulatory compliance.
Provide effective and timely communication to insurance plans to facilitate the best possible functional outcome with the resources available within the patients benefit structure.
Coordinate the integration of social services/case management functions into the patient care discharge and home planning processes with other center departments external service organizations agencies and health care facilities.
Conduct concurrent medical record reviews using specific indicators and criteria as approved by medical staff CMS and other state agencies.
Acts as patient advocate: investigates and reports adverse occurrences and performs staff education related to resource utilization discharge planning and psychosocial aspects of health care delivery.
Promote effective and efficient utilization of clinical resources.
Mobilizes resources and interviews as needed to achieve expected goals in order to assist in achieving desired clinical outcomes within the desired time-frame.
Ensure that patient tests are appropriate and necessary and are carried out within the established time-frame and that results are promptly available.
Conducts review for appropriate utilization of services from admission through discharge.
Evaluate patient satisfaction and quality of care provided.
Initiates and presents denial letters as appropriate.
Assesses patient care required throughout continuum of care for diagnosis procedures and reimbursement guidelines.
Communicates and collaborates with the center and regional interdisciplinary team members at regular intervals throughout the skilled nursing and rehabilitation stay while developing effective working relationships.
Assists the interdisciplinary team to maintain appropriate cost case and desired patient outcomes.
Complete expanded assessment of patients and family needs at time of admission.
Refers cases where patients and/or family would benefit from counseling required to complete complex discharge plan to social worker or center Director of Nursing.
Serve as a patient advocate. Enhances a collaborative relationship to maximize the patients and familys ability to make informed decisions.
Facilitates interdisciplinary patient care rounds and/or conferences to review treatment goals optimize resource utilization provide family education and identified post-admissions needs.
Collaborate with clinical staff in the development and execution of the plan of care and achievement of goals.
Directs and participates in the development and implementation of patient care policies and protocols in order to provide advice and guidance in handling special cases or patient needs.
Coordinates the provision of social services to patients families and significant others to enable them to deal with the impact of illness.
Qualifications
1) Associate degree in healthcare related field or Bachelors degree is preferred.
2) Minimum of two (2) years of utilization review/case management experience or social work experience.
3) Minimum of one (1) year experience in discharge planning from a skilled nursing center is preferred.
4) Maintains current professional licensure in nursing or professional field of certification. RN preferred
5) Medicare Skilled Nursing and Rehabilitation assessment criteria and reimbursement process strongly preferred.
6) Appropriate certification in case management preferred (e.g. Commission for Case Management Certification (CCMC); Association of Rehabilitation Nurses (ARN).
Required Experience:
Manager
Employment Type
Full-Time
