Case Manager (Licensed)

PACS Group; United States; On-site; USD 60,000 - 80,000; Full time

Job summary

PACS Group seeks a care coordinator to integrate clinical expertise with resident-centered planning. You will collaborate with residents, families, and healthcare providers to develop and implement cost-conscious care plans and ensure smooth admissions and discharges.

Qualifications include a Nursing or Social Work degree, RN license preferred, 2+ years clinical nursing experience, and knowledge of Medicare/Medicaid. Excellent communication and documentation skills are essential.

Qualifications

• Bachelor's Degree in Nursing or Social Work; RN license preferred or LVN/LPN acceptable.
• Two years of clinical nursing experience preferred.
• Knowledge of Medicare, Medi-Cal and Medicaid programs and benefits.
• CCM certification is a plus.
• Must maintain continuing education/licensing and be in good standing with Public Health.

Responsibilities

• Communicate plans of care with residents and families and care team.
• Attend morning meetings to facilitate team communication.
• Answer residents' questions about care and treatment plans.
• Monitor residents' status and adjust care as needed.
• Complete documentation and charting accurately and timely.
• Coordinate admissions and discharges and referrals.
• Coordinate care with providers, facilities, and payers.
• Perform utilization review to ensure cost-effective care.
• Maintain professional, respectful interactions with residents, families, staff, and partners.

Skills

Communication skills

Time management

Independent worker

Education

Bachelor's Degree in Nursing or Social Work

RN license preferred

CCM certification a plus

Tools

PCC Knowledge

Medicare/Medicaid knowledge

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.