Regional Case Manager (Remote)

Diversicare of Council Grove; United States; Remote; USD 65,000 - 85,000; Full time

Job summary

Join a leading healthcare provider as an RN Case Manager, focusing on patient care coordination and discharge planning. You'll collaborate with interdisciplinary teams to enhance patient management, ensuring continuity of care while providing exceptional service. This fully remote role offers the opportunity to make a significant impact in residents' lives.

Qualifications

• Degree in healthcare-related field preferred.
• Two years of case management experience required.
• Current professional licensure in relevant field.

Responsibilities

• Coordinate care and discharge planning for patients.
• Communicate with insurance for proper reimbursement levels.
• Conduct comprehensive patient assessments.

Skills

Patient Management

Communication

Advocacy

Discharge Planning

Coordination

Education

Bachelor's degree in 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 goal of this position is to enhance the quality of patient management and satisfaction, promote continuity of care and cost-effectiveness, and oversee utilization review and management as well as discharge planning. 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 appropriate level of care based on patient needs and reimbursement guidelines.
• Ensure the highest level of customer service to the managed care plan.
• Provide center case management/utilization review and discharge planning to ensure patient progression through the continuum of care and discharge to the least restrictive environment.
• Coordinate the integration of social services into patient care.
• Coordinate facility activities related to case management and discharge planning.
• Adhere to departmental goals, policies, and procedures, ensuring compliance with quality patient care and regulatory standards.
• Communicate effectively with insurance plans to facilitate optimal functional outcomes within the patient's benefit structure.
• Collaborate with other departments, external agencies, and healthcare facilities to integrate social services/case management functions into patient care, discharge, and home planning.
• Conduct concurrent medical record reviews using approved indicators and criteria.
• Act as a patient advocate by investigating adverse occurrences and educating staff on resource utilization, discharge planning, and psychosocial aspects.
• Promote efficient utilization of clinical resources and mobilize resources as needed.
• Ensure appropriate and necessary patient tests are conducted timely, with prompt availability of results.
• Review the 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 needs throughout the continuum for diagnosis, procedures, and reimbursement guidelines.
• Maintain regular communication and collaboration with the interdisciplinary team to develop effective working relationships.
• Assist the team in maintaining appropriate costs, case management, and desired patient outcomes.
• Complete comprehensive assessments of patients and families at admission.
• Refer cases needing counseling or complex discharge planning to social workers or the Director of Nursing.
• Serve as a patient advocate, fostering collaborative relationships to help patients and families make informed decisions.
• Facilitate interdisciplinary rounds and conferences to review treatment goals, optimize resources, and provide family education.
• Collaborate in developing and executing care plans and policies to address special cases or patient needs.
• Coordinate social services to support patients and families dealing with illness impacts.

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 is 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 is required.
• Appropriate certification in case management (e.g., CCMC, ARN) is preferred but not required.