Regional Case Manager (Remote)

Diversicare of Larned; United States; Remote; USD 60,000 - 80,000; Full time

Job summary

A leading healthcare organization is seeking an RN Case Manager to enhance the quality of patient management. This fully remote position involves care coordination and discharge planning, requiring strong interpersonal skills and a dedication to patient advocacy. Candidates should hold a healthcare-related degree with relevant experience in case management and discharge planning.

Qualifications

• Degree in healthcare field (RN, PT, OTR, SLP, or MSW).
• Minimum two years of case management/utilization review experience.
• Current professional licensure required.

Responsibilities

• Accountable for care coordination and discharge planning.
• Communicates with insurance case managers for authorizations.
• Acts as a patient advocate, ensuring continuity of care.

Skills

Customer Service

Care Coordination

Advocacy

Interdisciplinary Communication

Utilization Review

Education

Bachelor's degree in a healthcare-related field

Job description

Overview

Make a Difference in our Residents' Lives! Diversicare Healthcare Services is seeking an outstanding RN Case Manager who has a passion for providing the highest quality of care with compassion and integrity! We live our Core Values of Integrity, Excellence, Compassion, and Teamwork & Stewardship every day with every life we touch, providing exceptional healthcare and exceeding expectations.

RN Case Manager

Our case managers are accountable for the care, coordination, and discharge planning of our patients. They provide ongoing support and expertise through comprehensive assessment, planning, implementation, and overall evaluation of individual patient needs. The overall goal of the position is to enhance the quality of patient management and satisfaction, promote continuity of care and cost-effectiveness, utilization review and management, as well as discharge planning. Additionally, this is a home-based and fully remote RN Case Manager position.

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Responsibilities

• This position requires multi-tasking to ensure managed care authorizations are received at the highest level of reimbursement and as quickly as possible.
• Communicate with insurance case managers to obtain authorization for the correct level of care according to the patients' needs under the reimbursement guidelines provided by the patient's benefits and current managed care contract.
• Ensure the highest level of customer service to the managed care plan.
• Provide center case management/utilization review and discharge planning to ensure the patient progresses through the continuum of care and is discharged to the least restrictive environment.
• Coordinate the integration of the social service function into patient care.
• Coordinate facility activities concerned with case management and discharge planning.
• Adhere to departmental goals, objectives, standards of performance, policies, and procedures.
• Ensure compliance with quality patient care and regulatory standards.
• Provide effective and timely communication to insurance plans to facilitate the best possible functional outcome within the patient's benefit structure.
• Coordinate the integration of social services/case management functions into patient care, discharge, and home planning processes with other center departments, external service organizations, agencies, and healthcare facilities.
• Conduct concurrent medical record reviews using specific indicators and criteria as approved by medical staff, CMS, and other state agencies.
• Act as a patient advocate: investigate and report adverse occurrences, and perform staff education related to resource utilization, discharge planning, and psychosocial aspects of healthcare delivery.
• Promote effective and efficient utilization of clinical resources.
• Mobilize resources and interview as needed to achieve expected goals and desired clinical outcomes within the set time-frame.
• Ensure patient tests are appropriate, necessary, and carried out within the established time-frame, with results promptly available.
• Conduct reviews for appropriate utilization of services from admission through discharge.
• Evaluate patient satisfaction and quality of care provided.
• Initiate and present denial letters when appropriate.
• Assess patient care required throughout the continuum of care for diagnosis, procedures, and reimbursement guidelines.
• Communicate and collaborate with the interdisciplinary team at regular intervals during the patient's stay, developing effective working relationships.
• Assist the team in maintaining appropriate costs, case management, and patient outcomes.
• Complete expanded assessments of patients and family needs at admission.
• Refer cases where patients and/or families would benefit from counseling to social workers or the Director of Nursing.
• Serve as a patient advocate, fostering a collaborative relationship to help patients and families make informed decisions.
• Facilitate interdisciplinary patient care rounds and conferences to review treatment goals, optimize resource utilization, and provide education.
• Collaborate with clinical staff in developing and executing the plan of care and achieving goals.
• Develop and implement patient care policies and protocols to handle special cases or needs.
• Coordinate social services for patients, families, and significant others to help them cope with illness.

Qualifications

• Degree in a healthcare-related field – RN, PT, OTR, SLP, or MSW with a Bachelor's degree or higher preferred
• Minimum of two (2) years of case management/utilization review experience
• Minimum of one (1) year experience in discharge planning from a skilled nursing center preferred
• Maintain current professional licensure and/or certification in one of the above fields
• Knowledge of Medicare and Managed Care Skilled Nursing and Rehabilitation assessment criteria and reimbursement processes required
• Appropriate certification in case management (e.g., CCMC, ARN) is preferred but not required