Regional Case Manager (Remote)

Diversicare Healthcare Services - Birmingham, AL; United States; Remote; USD 70,000 - 90,000; Full time

Job summary

A leading healthcare services company seeks an RN Case Manager to enhance patient management and satisfaction through comprehensive assessment and care planning. This remote position involves coordination with insurance and interdisciplinary teams to ensure optimal patient outcomes.

Qualifications

• RN, PT, OTR, SLP, or MSW preferred.
• Minimum two years of case management experience.
• Current licensure and/or certification required.

Responsibilities

• Ensure managed care authorizations are processed efficiently.
• Coordinate discharge planning and integration of social services.
• Conduct comprehensive patient assessments at admission.

Skills

Communication

Patient Advocacy

Coordination

Education

Degree in healthcare-related field

Bachelor's degree or higher preferred

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, facilitate utilization review and management, and 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 patient's 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 social services into patient care.
• Coordinate facility activities related to 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.
• Communicate effectively and timely with insurance plans to facilitate optimal outcomes within the patient's benefit structure.
• Coordinate social services/case management functions into patient care, discharge, and home planning processes with other departments, external organizations, and agencies.
• Conduct concurrent medical record reviews using specific indicators and criteria approved by medical staff, CMS, and other agencies.
• Act as a patient advocate: investigate adverse occurrences and perform staff education related to resource utilization, discharge planning, and psychosocial health care aspects.
• Promote efficient utilization of clinical resources.
• Mobilize resources and conduct interviews as needed to achieve clinical goals within desired timeframes.
• Ensure patient tests are appropriate, necessary, and performed within established timeframes, with results promptly available.
• Review the appropriateness 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 based on diagnosis, procedures, and reimbursement guidelines.
• Communicate and collaborate with the interdisciplinary team regularly during the patient's stay to develop effective working relationships.
• Assist the team in maintaining appropriate costs, case management, and patient outcomes.
• Complete comprehensive assessments of patients and families at admission.
• Refer cases needing counseling to social workers or the Director of Nursing.
• Serve as a patient advocate, fostering collaborative relationships to support informed decision-making.
• Facilitate interdisciplinary rounds and conferences to review treatment goals, optimize resources, educate families, and identify post-admission needs.
• Collaborate with clinical staff to develop and execute care plans and achieve goals.
• Develop and implement patient care policies and protocols, providing guidance for special cases or needs.
• Coordinate social services to support patients, families, and significant others in dealing with illness impacts.

Qualifications

• Degree in 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 licensure and/or certification in the relevant field.
• Knowledge of Medicare and Managed Care Skilled Nursing and Rehabilitation assessment criteria and reimbursement processes is required.
• Certification in case management (e.g., CCMC, ARN) is preferred but not required.