Regional Case Manager (Remote)

Tylertown Nursing & Rehab Center; United States; Remote; USD 70,000 - 90,000; Full time

Job summary

A leading healthcare provider is seeking an experienced RN Case Manager to provide high-quality patient care in a fully remote position. This role involves care coordination, discharge planning, and patient advocacy, ensuring proper resource utilization and enhancing patient satisfaction. Candidates should have a healthcare-related degree, experience in case management, and the ability to work collaboratively with interdisciplinary teams.

Qualifications

• At least two years of case management or utilization review experience.
• At least one year of discharge planning experience in skilled nursing setting preferred.
• Current licensure in relevant healthcare field.

Responsibilities

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

Skills

Patient Advocacy

Utilization Review

Assessment

Care Coordination

Education

Degree in a 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 is passionate about providing the highest quality of care with compassion and integrity. We live our Core Values of Integrity, Excellence, Compassion, and Teamwork & Stewardship every day by touching lives 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 improve 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 promptly at the highest reimbursement level.
• Communicate with insurance case managers to obtain authorization for appropriate care levels based on 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 through care and discharge to the least restrictive environment.
• Coordinate social services into patient care plans.
• Manage facility activities related to case management and discharge planning.
• Adhere to departmental goals, policies, and procedures, ensuring compliance with quality and regulatory standards.
• Communicate effectively with insurance plans to optimize patient outcomes within benefit resources.
• Coordinate social services and case management functions with other departments and external organizations.
• Conduct concurrent medical record reviews using approved indicators and criteria.
• Act as a patient advocate by investigating adverse events and educating staff on resource utilization and psychosocial aspects.
• Promote efficient use of clinical resources and ensure timely testing and results.
• Review service utilization from admission to discharge.
• Evaluate patient satisfaction and quality of care.
• Prepare and present denial letters when appropriate.
• Assess patient care needs throughout the continuum based on diagnosis, procedures, and reimbursement guidelines.
• Collaborate with the interdisciplinary team to develop and implement care plans and achieve clinical goals.
• Complete comprehensive assessments of patients and families at admission.
• Refer cases needing counseling or complex discharge planning to social workers or nursing leadership.
• Facilitate interdisciplinary rounds and family education sessions.
• Develop and advise on patient care policies and protocols for special cases.
• Coordinate social services to support patients and families in managing illness impacts.

Qualifications

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