Case Manager (Cm)

Luxe at Wellington Rehabilitation Center is seeking a Case Manager

The Case Manager (CM) plays an integral role in optimizing the plan of care for Managed Care patients. The Case Manager (CM) holds a license in nursing and is responsible for the timely compilation, review and submission of medical information relating to the post-acute skilled stay. By serving as the liaison between the patient, physician interdisciplinary care team members, and the payer; this position coordinates, monitors, advocates and communicates the patients progress and cost evaluation while assisting with and coordinating an efficient and smooth coordination to the next level of care.
RESPONSIBILITIES:

• Ensure Case Manager coverage is provided for the facility.

• Develop a comprehensive system to ensure clinical updates are complete and accurate before submission.

• Assess residents’ care needs and review documentation required for authorization to a Skilled Nursing Facility. Ensure documentation supports managed care/payor’s requirements (InterQual and Milliman Care Guidelines).

• Ability to review and understand contract terms and requirements for Skilled Nursing Services.

• Meet submission deadlines of concurrent reviews to the managed care payor.

• Assist facilities with the determination and facilitation of discharge planning/transition of care appropriateness for the patient (Home Health, DME, NOMNC/Non-Coverage Letters).

• Communicate continued stay matters and complex cases with internal facility staff (Utilization Review Committee) and managed care payor.

• Collaborate with internal facility team (Clinical, Therapy, Social Services, Admissions, Business Office, and Billing) to facilitate protocols/outcomes for managed care patients.

• Understand, interpret, and apply managed care payor contracts for the appropriate leveling of patients for reimbursement and any carve-out/stop loss clauses. Assist corporate billing department with billing issue on behalf of patients/members.

• Provide education as needed to individual facility staff members in relation to timely submissions, documentation, etc.

• Collaborate with nurse managers and regional and corporate team members to identify specific learning UR Meeting/documentation needs of the facilities, regions, or companywide.

• Prepare, participate, and assist with Quality Assurance and Performance Improvement (QAPI) programs, projects, meetings, and training.

QUALIFICATIONS: EDUCATION / EXPERIENCE:

• Must have an active license in nursing (LPN/RN).

• Substantial work experience relevant to case management, care planning, discharge planning, and clinical chart reviews.

• Work experience in post-acute care, skilled nursing facilities, long-term care, or assisted living.

• Demonstrated leadership and supervisory skills in the areas of case management and employee relations management.

• Basic Knowledge of nursing and medical practices and procedures, as well as state and federal regulations specific to nursing home operation and licensure.

• Must possess leadership and supervisory ability and the willingness to work harmoniously with residents, families, vendors, visitors, government agencies, facility staff, hospital personnel, hospice representatives, and the general public.

• Must possess the ability to plan, organize, develop, implement, and interpret programs, goals, objectives, policies, and procedures, etc., that are necessary for providing quality individualized care.

• Ability to formulate reports, disseminate information, interpret data, and coordinate with multiple departments.

• Ability to read and interpret documents such as safety rules, operating and maintenance instructions and procedure manuals.

• Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Ability to interpret a variety of instructions furnished in written, oral, diagram or schedule form.

Why Join Us

• Competitive Compensation.

• Great Benefits Package.

• Engaging Work Atmosphere.

• Innovative Training Programs.

• Excellent Growth Opportunities.

• And So Much More!

Click APPLY to join Luxe at Wellington Rehabilitation Center!