Address
Form of workJOB SUMMARY:
Performance of clinical assessments for potential and current Florida Presbyterian Homes health center residents. Negotiation for residents who are clients of managed care organizations. Liaise between community relations, discharge planners, and Physicians. Must support the Marketing efforts at the community. Maximize cost effectiveness across the entire continuum of care; improve customer satisfaction and enhance quality of care.ESSENTIAL JOB FUNCTIONS: Comply with all applicable rules, standards and guidelines related to employment with Florida Presbyterian Homes.
ESSENTIAL QUALIFICATIONS:
- Works as community liaison for referrals from physician, hospitals, insurancebased case manager, or marketing personnel on all potential sub- acute patients, ensures initial and on-going fiscal appropriateness of member admissions in conjunction with Business Office and Director of Nursing.
- Assists the community with tracking of authorization numbers of residents on Managed Medicaid and other Managed Care Insurance plans.
- Works with community staff to monitor and track resident's progress and communicate relevant information between resident, referrer, family, insurance company, and treatment team, communicates with the interdisciplinary member care team.
- Works with residents, families and other staff as needed to ensure that residents are evaluated for the appropriate level of care.
- Assists with coordination, monitoring, and communication of resident's progress and costs.
- Fosters positive relationships with insurance representatives and providers in the local market.
- Address quality measures issues for potential admissions and returning residents.
- Complete Pre-Admission process in EHR for new admissions.
The above job description is not to be construed as a complete listing of the assignments
and responsibilities assigned to any employees; nor are such assignments restricted to
those precisely listed in this description. This job description may change from time to time as the needs of the organization change.
ESSENTIAL QUALIFICATIONS:
Education/Licensure: Must be a licensed RN or LPN in the state of Florida; or possess a
degree in a related healthcare field.
Certification in Case Management or Geriatrics preferred Must be CPR Certified
Experience: Two years (three years, if LPN) in long term care and assisted living,
including working knowledge of case management/ clinical work,
Medicare /Managed care and Managed Medicaid protocols. One
year in post-acute rehabilitation. Case management purpose and
process knowledge required. Demonstrated clinical assessment
skills required.
Physical and Environmental Requirements:
Fingering Pushing
Grasping Reaching
Kneeling Stooping
Lifting up to 40lbs. Driving
Sensory and communicative activities with or without prosthetics of this position are:
Feeling Smelling
Hearing Speaking
Seeing
An individual in this position will be exposed to:
External environment conditions
Inside environmental conditions
Bloodborne pathogens
Respiratory pathogens
Must be able to cope with mental and emotional stress of this position.
