Case Manager

PACS; Grand View (AZ); On-site; USD 65,000 - 90,000; Full time

Job summary

PACS in Arizona is seeking a qualified RN or social work professional to lead case management and coordinate care for residents. You will assess needs, develop plans, and collaborate with families, physicians, and payers to ensure high-quality, cost-effective care.

The role emphasizes documentation, adherence to Medicare/Medicaid guidelines, and timely admissions and discharges while maintaining professional communications in a busy facility.

Qualifications

• Bachelor’s Degree in Nursing or Social Work required or preferred.
• Two (2) years of clinical nursing experience preferred.
• Knowledge of Medicare, Medi-Cal and Medicaid programs and benefits.
• PCC knowledge preferred.
• Certificate as a CCM a plus.
• Must maintain all required continuing education/licensing.
• Must remain in good standing with relevant health departments.

Responsibilities

• Communicate regularly with residents and their family about Plans of Care and treatment protocols.
• Attend and participate in morning meetings to facilitate team communications.
• Answer residents’ questions about care, treatment plans, and illness progression.
• Monitor and adjust residents’ statuses based on changing needs.
• Organize and prioritize daily work by assessing residents’ needs in the area of responsibility.
• Complete documentation as required.
• Perform utilization review activities to ensure cost-effective care.
• Coordinate care with residents, care providers, facilities, and third-party payers.
• Oversee admissions and discharge activities.
• Coordinate referrals to and from the facility.
• Maintain professional interactions with residents, families, staff and partners.
• Accurate charting and timely paperwork.

Skills

Clinical nursing experience

Case management knowledge

Medicare/Medicaid knowledge

PCC knowledge

Education

Bachelor’s Degree in Nursing or Social Work

RN license preferred; LVN/LPN acceptable

Job description

General Purpose

• Utilize clinical expertise and critical thinking skills to work collaboratively with residents, resident family/significant other, healthcare providers, insurers, community resources and other involved parties to develop and implement a plan of care that provides extraordinary care for the patient while being sensitive to costs and resources.

Essential Responsibilities

• Communicate regularly with residents and their family about Plans of Care, PT, OT and other treatment protocols.

• Attends and participates in morning meetings/stand up to facilitate communications with the team.

• Answer residents’ questions about their care, treatment plans, illness progression and all other issues so they feel safe and secure in our care.

• Monitor and adjust residents’ statuses based on changing needs and conditions.

• Organize and prioritize daily work by assessing new, current and discharging residents' needs in the area(s) of responsibility.

• Complete documentation as required.

• Performs utilization review activities to provide resident appropriate, timely and cost-effective care.

• Coordinate care with resident, care providers, facilities financial services, and third-party payers.

• Oversee all admissions and discharge activities.

• Coordinate referrals both to and from our facility.

• Ability to relate positively, effectively, and appropriately with residents, families, staff and professionals

• colleagues.

• Accurate charting and ability to complete necessary paperwork in a timely manner.

• Ability to work independently and exercise sound judgement in interactions with physicians, providers, payers and residents and their families.

• Must be able to effectively communicate with, and promote cooperation and collaboration between individuals including residents/families/caretakers, physicians, nurses and other ancillary partners.

• Must have excellent time management skills to develop organized work processes in a high-volume environment with rapidly changing priorities.

• Intermediate computer skills.

• Competence in maintaining professional, respectful, honest interactions with residents/families and staff and partners.

• Perform clinical assessments, care planning, and direct coordination of medical services when required by the role

Supervisory Requirements

This position has no supervisory responsibilities.

Qualification

Education and/or Experience

• Bachelor’s Degree in Nursing or Social Work. Registered Nurse (RN) license preferred. Licensed (LVN or LPN) nurse acceptable.

• Two (2) years of clinical nursing experience preferred.

• Knowledge of Medicare, Medi-cal and Medicaid programs and benefits.

• PCC Knowledge preferred.

• Certificate as a certified Case Manager (CCM) a plus.

• Must maintain all required continuing education/licensing.

• Must remain in good standing with the Department of Public Health, License and Certification Division at all times.

Physical Demands

• Primarily sedentary with frequent sitting, computer use, and documentation.

• Regular walking throughout the facility to meet with residents, families, and staff.

• Occasional standing during meetings and care conferences.

• Ability to lift and carry up to 20 pounds (files, binders, supplies).

• Clear verbal communication and vision required for chart review and resident interaction.

Work Environment

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

The noise level in the work environment is usually low to moderate.

We are an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected veteran status, or any other legally protected status.