Regional Case Manager (Remote)

Diversicare of Batesville; United States; Remote; USD 70,000 - 90,000; Full time

Job summary

A leading healthcare services company is looking for an RN Case Manager to provide compassionate care and manage patient cases. This fully remote position involves coordination, discharge planning, and advocating for patient needs while ensuring compliance with healthcare standards. Ideal candidates will possess a healthcare-related degree, along with experience in case management and discharge planning.

Qualifications

• Degree in a healthcare-related field, Bachelor's preferred.
• 2+ years of case management/utilization review experience.
• 1+ year of discharge planning experience preferred.

Responsibilities

• Ensure managed care authorizations are received promptly.
• Conduct utilization review and discharge planning.
• Communicate with insurance to optimize patient outcomes.

Skills

Communication

Patient Advocacy

Care Coordination

Time Management

Problem Solving

Education

Degree in healthcare (RN, PT, OTR, SLP, MSW)

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, touching lives through exceptional healthcare and exceeding expectations.

RN Case Manager

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

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Responsibilities

• Ensure managed care authorizations are received at the highest reimbursement level promptly.
• Communicate with insurance case managers to obtain authorization for appropriate care levels according to patient needs and reimbursement guidelines.
• Provide excellent customer service to managed care plans.
• Conduct center case management/utilization review and discharge planning to facilitate patient progression and discharge to the least restrictive environment.
• Coordinate social services integration into patient care.
• Manage facility activities related to case management and discharge planning.
• Adhere to departmental goals, policies, and standards of performance.
• Ensure compliance with quality patient care and regulatory standards.
• Communicate effectively with insurance plans to optimize patient outcomes within benefit structures.
• Coordinate social services and case management functions across departments and external agencies.
• 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 and psychosocial aspects.
• Promote effective utilization of clinical resources.
• Mobilize resources to achieve clinical goals within desired timeframes.
• Ensure timely and appropriate patient testing and results.
• Review utilization of services from admission to discharge.
• Evaluate patient satisfaction and quality of care.
• Prepare and present denial letters when necessary.
• Assess patient care needs throughout the continuum based on diagnosis, procedures, and reimbursement guidelines.
• Collaborate with interdisciplinary teams regularly to develop and review care plans.
• Assist in developing patient care policies and protocols.
• Coordinate social services to support patients and families in managing illness impact.

Qualifications

• Degree in a healthcare-related field (RN, PT, OTR, SLP, MSW) with a Bachelor's degree or higher preferred.
• At least two (2) years of case management/utilization review experience.
• At least one (1) year of discharge planning experience in a skilled nursing center is preferred.
• Current professional licensure and/or certification in a relevant field.
• Knowledge of Medicare and Managed Care assessment and reimbursement processes.
• Certification in case management (e.g., CCMC, ARN) is preferred but not required.