Regional Case Manager (Remote)

Diversicare of Shelby; United States; Remote; USD 60,000 - 90,000; Full time

Job summary

Join a leading healthcare provider as an RN Case Manager, where you'll enhance patient care through effective coordination and management. This fully remote position involves responsibilities like care planning, insurance communication, and regulatory adherence, all centered on excellence in patient outcomes and satisfaction. A commitment to integrity and compassion is key as you navigate case management in a supportive environment for both patients and their families.

Qualifications

• At least two (2) years of case management/utilization review experience.
• Current professional licensure in the relevant field.
• Knowledge of Medicare and Managed Care assessment criteria.

Responsibilities

• Ensure managed care authorizations are received promptly and coordinate discharge planning.
• Conduct utilization review and maintain compliance with regulations.
• Integrate social services into care plans and advocate for patient needs.

Skills

Communication

Patient Advocacy

Utilization Review

Care Coordination

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, 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 through comprehensive assessment, planning, implementation, and evaluation of individual patient needs. The main goal 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 promptly at the highest reimbursement level.
• 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 through care 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, standards, and compliance requirements.
• Ensure quality patient care and regulatory compliance.
• Maintain effective communication with insurance plans to optimize patient outcomes within benefit structures.
• Integrate social services and case management into patient care, discharge, and home planning with other departments and external organizations.
• Perform concurrent medical record reviews based on approved indicators and criteria.
• Act as a patient advocate by investigating adverse events and educating staff on resource utilization and discharge planning.
• Promote efficient utilization of clinical resources.
• Mobilize resources and conduct interviews to achieve clinical outcomes within desired timeframes.
• Ensure timely and appropriate patient testing and result availability.
• Review service utilization from admission through discharge.
• Evaluate patient satisfaction and quality of care.
• Prepare and present denial letters as needed.
• Assess patient care needs throughout the continuum based on diagnosis, procedures, and reimbursement guidelines.
• Collaborate with interdisciplinary teams regularly to develop effective working relationships.
• Assist in maintaining cost, case, and patient outcome goals.
• Complete comprehensive assessments of patient and family needs at admission.
• Refer cases requiring counseling to social workers or nursing leadership.
• Serve as a patient advocate, fostering collaborative decision-making.
• Facilitate interdisciplinary rounds and conferences to review treatment goals and optimize resource use.
• Collaborate on developing and executing care plans and achieving goals.
• Develop and implement patient care policies and protocols for special cases or needs.
• Coordinate social services to support patients and families in 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.
• At least two (2) years of case management/utilization review experience.
• At least one (1) year experience in discharge planning from a skilled nursing center is preferred.
• Current professional licensure and/or certification in the relevant field.
• Knowledge of Medicare and Managed Care Skilled Nursing and Rehabilitation assessment criteria and reimbursement processes.
• Certification in case management (e.g., CCM, ARN) is preferred but not required.