Regional Case Manager (Remote)

St. Martin's in the Pines- A Diversicare...; United States; Remote; USD 60,000 - 80,000; Full time

Job summary

A leading healthcare provider is looking for a passionate RN Case Manager to coordinate care and enhance patient satisfaction. In this fully remote role, you will oversee discharge planning and ensure compliance with healthcare regulations while working collaboratively with an interdisciplinary team.

Qualifications

• Minimum of two (2) years of case management experience.
• Maintain current professional licensure as RN/related field.
• Knowledge of Medicare and reimbursement processes required.

Responsibilities

• Coordinate patient care through assessment, planning, and evaluation.
• Communicate with insurance for care authorizations.
• Ensure compliance with quality patient care standards.

Skills

Case management

Patient advocacy

Communication

Coordination of care

Customer service

Education

Degree in healthcare-related field (RN, PT, OTR, SLP or 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 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 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.
• 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 the patient care, discharge, and home planning processes with other departments, external service organizations, agencies, and healthcare facilities.
• Conduct concurrent medical record reviews using specific indicators and criteria 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 timeframe.
• Ensure patient tests are appropriate, necessary, and carried out within the established timeframe, with results promptly available.
• Review for appropriate utilization of services from admission through discharge.
• Evaluate patient satisfaction and quality of care provided.
• Initiate and present "denial letters" as appropriate.
• Assess patient care needs throughout the continuum of care for diagnosis, procedures, and reimbursement guidelines.
• Communicate and collaborate with the interdisciplinary team regularly to develop effective working relationships.
• Assist the team in maintaining appropriate costs, case management, and desired patient outcomes.
• Complete expanded assessments of patients and family needs at admission.
• Refer cases requiring counseling to social workers or the Director of Nursing.
• Serve as a patient advocate, maximizing the patient's and family's ability to make informed decisions.
• Facilitate interdisciplinary rounds and conferences to review treatment goals, optimize resources, and provide education.
• Collaborate with clinical staff in developing and executing the plan of care.
• Develop and implement patient care policies and protocols for handling special cases or needs.
• Coordinate social services to patients, families, and significant others to help them deal with illness impacts.

Qualifications

• Degree in healthcare-related field – RN, PT, OTR, SLP, or MSW with a Bachelor's degree or higher is 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 is preferred (e.g., CCMC, ARN), but not required