Case Manager LVN

Cambridge Healthcare Services, LLC; Laguna Hills (CA); On-site; USD 85,000 - 125,000; Full time

Job summary

Cambridge Healthcare Services, LLC in Laguna Hills, CA seeks a dedicated Case Manager to coordinate delivery of services for managed care and Medicare residents, ensuring compliance with current standards and regulations. The role monitors cost effectiveness, manages admissions and discharges, advocates for residents and families, and liaises with insurers and medical management professionals.

Excellent communication and teamwork are essential.

Qualifications

• Minimum of 1 year case management experience in skilled nursing facility preferred
• Must have 5 or more years as a licensed nurse
• Excellent verbal and written skills
• Knowledge of Point Click Care helpful

Responsibilities

• Managing all types of insurance cases from admission through discharge
• Following up with residents’ post-discharge follow up
• Communicating by phone or in writing the resident’s status and changes in care plan to payer
• Documenting all payer interactions regarding resident progress and expected outcomes
• Maximizing benefits by coordination of cost effective care
• Meeting with facility interdisciplinary team to coordinate services and ensure total regimen of resident care is achieved
• Frequently speaking with business office and collaborating with other departments to ensure accurate census and payment of residents
• Daily review of medical records to confirm compliance with medical necessity
• Planning and organizing time and duties to efficiently maintain caseload
• Protecting each residents file and data with confidentially per HIPAA standards

Skills

Case management

Nursing background

Verbal communication

Written communication

Education

Completion of nursing training from accredited school

Valid nursing license

Valid CPR and BLS card

Tools

Point Click Care

Job description

POSITION SUMMARY

The purpose of your job position is to coordinate delivery of services to managed care and Medicare residents in accordance with current federal, state and local standards and regulations that govern the facility and in collaboration with the Administrator, Director of Marketing, and other facility staff.

The Case Manager monitors and documents the cost effectiveness of treatment provided, coordinates the admission and discharge process, serves as the resident/family advocate, and acts as liaison to insurance and medical management professionals. They will treat each resident fairly, kindly, and show them dignity and respect. They will refer to each resident by their name. They will communicate clearly, empathetically, and effectively when speaking to residents, family members, visitors, all staff and governmental agencies. They will work cooperatively with all departments and multidisciplinary teams. They will demonstrate patience, initiative and willingness to assist residents that may be difficult. They will relate all pertinent information concerning a resident’s condition to a charge nurse when required. They will be committed to always doing the right thing.

ESSENTIAL DUTIES AND RESPONSIBILITIES

• Managing all types of insurance cases from admission through discharge

• Following up with residents’ post-discharge follow up

• Communicating by phone or in writing the resident’s status and changes in care plan to payer

• Documenting all payer interactions regarding resident progress and expected outcomes

• Maximizing benefits by coordination of cost effective care

• Meeting with facility interdisciplinary team to coordinate services and ensure total regimen of resident care is achieved

• Frequently speaking with business office and collaborating with other departments to ensure accurate census and payment of residents

• Daily review of medical records to confirm compliance with medical necessity

• Planning and organizing time and duties to efficiently maintain caseload

• Reporting any occupational exposures to blood, body fluids, or other hazardous materials to a supervisor immediately

• Protecting each residents file and data with confidentially per HIPAA standards

• Abiding with all facility policies and procedures including not disclosing user ID codes and passwords

Every effort has been made to identify the essential functions of this position. However, it in no way states or implies these are the only duties you will be required to perform as directed by management. The omission of specific statements of duties does not exclude them from the position if the work is similar, related, or is an essential function of the position.

REQUIREMENTS

Education / Licensure

• Completion of nursing training from accredited school or college

• Valid nurses license in good standing

• Valid CPR and BLS card

Qualifications / Experience

• Minimum of 1 year case management experience in skilled nursing facility preferred

• Must have 5 or more years as a licensed nurse

• Excellent verbal and written skills

• Knowledge of Point Click Care helpful

Working Conditions

• May encounter frequent interruptions

• May be involved with residents, family and government agencies

• May be requested to work beyond scheduled working hours at times

• Is subject to call-back during emergency conditions (e.g., severe weather, evacuation, post-disaster, etc.)

• May be necessary to assist in the evacuation of residents during emergency situations

• May be exposed to infectious waste, diseases, conditions, etc., including TB and the AIDS and Hepatitis B viruses

Physical Requirements

• Must be able to move intermittently throughout the day

• Working throughout the nursing areas

• Repetitive hand motion

• Ability to read fine print on progress notes and/or medical labels