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Form of workNorthern Nevada State Veterans Home is seeking a RN Case Manager to assume the Director of Social Services Role. Wage is hourly $41.00-$46.10.
Working with our Veterans in our home is so much fun and rewarding!
This position does oversee one Licensed Social Worker. Position also requires attendance to all patient care conferences.
JOB SUMMARY: 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.
Minimum Qualifications:
• RN degree in the health & human service field preferred.
• Current, active, and unrestricted licensure or certification in a health or human services discipline preferred.
• Minimum two (2) years’ experience in medical case management preferred.
Knowledge/Skills/Abilities: Comprehensive knowledge of Medicare, Medicaid insurance, and managed care, required.
• Ability to negotiate coverage and provide complete and timely case management reports, required.
• Familiarity with long- term care and/or sub-acute care, useful.
• Strong oral and written communication skills, required. Essential Job Functions • Negotiates appropriate level of care within contract terms with the payor Case Manager.
• Utilizes Letter of Agreement 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 referrals of patients.
• Acts as a liaison between payors and decision makers facilitating a smooth transfer of information. Assists in program evaluation as requested.
• Maintains primary focus of census development and revenue enhancement.
• Provides documentation of contract or payor information on a timely basis to treatment team and business office billing staff, following case management policies.
• Monitors that records pulled for insurance provider requests are complete and appropriate • Monitors census and profitability of managed care patients.
• Assists with the appeal process when appropriate and upon request.
• Maintains all operational documentation as indicated by Corporate and Facility management
• Coordinates work between departments • Maintains confidentiality of necessary information •
• Obtains pre-authorizations for ancillary services if required.
• Participates in discussion of the case management patient’s status towards the goal to the next level of care with IDT team • Provides concurrent review to MCO Case Manager as required.
• Provides accurate and timely documentation and summaries if required by MCO (in addition to copies of the medical record).
• Meets with patient and/or family to discuss insurance coverage or benefits.
• Participates in case management conference calls and trainings.
Performs any miscellaneous work assignments as may be required • Every effort has been made to make your job description as complete as possible. However, it in no way states or implies that these are the only duties you will be required to perform. The omission of specific statements of duties does not exclude them from the position if the work is similar, related or is a logical assignment to the position.
