Case Manager

Pine Creek Care Center; Roseville (CA); On-site; USD 90,000 - 110,000; Full time

Job summary

Pine Creek Care Center is seeking an experienced Nurse Case Manager to collaborate with residents, families and health professionals to develop care plans that balance quality and costs. You will participate in rounds, coordinate admissions and referrals, and ensure comprehensive documentation.

The role requires a Nursing or Social Work background, RN or LVN/LPN licensure, and familiarity with Medicare/Medi-Cal/Medicaid.

Qualifications

• Bachelor's degree in Nursing or Social Work.
• RN license preferred; LVN/LPN acceptable.
• CCM certification is a plus.
• Knowledge of Medicare, Medi-Cal and Medicaid programs.

Responsibilities

• Communicate with residents and families about care plans and treatment.
• Attend morning meetings to coordinate with the care team.
• Answer questions about care, illness progression and plans.
• Monitor and adjust resident statuses based on needs.
• Organize daily work by assessing resident needs and discharges.
• Complete required documentation accurately and timely.
• Perform utilization review for appropriate, cost-effective care.
• Coordinate care with providers, facilities finance, and third-party payers.
• Oversee admissions and discharge activities and referrals.
• Maintain professional interactions with residents, families and staff.

Skills

Communication

Time management

Team collaboration

Clinical coordination

Education

Bachelor's degree in Nursing or Social Work

RN license preferred

LVN/LPN license acceptable

CCM certification a plus

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.

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.