Care Manager, RN

Our culture and people are what set us apart from other post-acute care providers. We’re dedicated to the growth and development of our team to set them up for success. We CARE for our patients like they are our own FAMILY.               

Note: The Centers for Medicare & Medicaid Services (CMS), in collaboration with the Centers for Disease Control and Prevention (CDC), require COVID-19 vaccinations for all Medicare and Medicaid certified providers.  Based on this regulation, all of our employees must be fully vaccinated or have a valid exemption.

SUMMARY:

The RN Care Manager is responsible for the development, oversight and continuity of the patient plan of care, serving as the liaison for collaboration and communication with the field staff. The RN Care Manager will participate in the interdisciplinary team meetings to ensure tight collaboration and appropriate care planning and delivery. This role will manage health care costs by influencing patient care decisions for value-based care delivery, visit type, frequency and calendar plotting cadence based on medical necessity review and utilization management guidelines. The RN Care Manager will assess for real time patient clinical, functional and behavioral health status to ensure rapid follow up, and allocation of services. The RN Care Manager will work alongside branch operations to ensure a holistic approach to patient care. The RN Care Manager will be integral in contributing to the development of new and / or revised work processes, policies and procedures relating to the ASHN Care Management Program.

MAJOR AREAS OF RESONSBILITITY:

• Plan of Care (POC) review and revision to reflect accuracy and regulatory standards

• Recertification/Discharge review and recommendation

• Utilization/Calendar Management

• Adhere to Utilization Management Guidelines

• Participate in Interdisciplinary Team Meetings and Agency Townhall Meetings

• Seek opportunities to contain cost

• Review Charts to monitor compliance with regulatory and governmental regulations

• Meets productivity standards and workflow expectations

• Functions as a resource for clinicians, agency staff, and internal staff

• Collaborates with clinicians as necessary for documentation clarification or educational opportunities

• Attends in-service trainings and mandatory agency meetings

• Stays current with CMS guidelines and Oasis Guidelines

• Read and adhere to all Agency Policies and Procedures and follow Employee Handbook Guidelines

• Completes and submits all required documentation within specified company requirements

• Other duties as assigned

QUALIFICATIONS:

• Registered Nurse licensure required

• Two years home care field experience preferred

• One-year clinical review preferred

• Two years case management and/or utilization management experience preferred

• Demonstrates exceptional collaboration skills

• Self-starter and innovative problem solver

• Proficiency in HCHB preferred

• Knowledge of Medicare, Medicaid and all State/Federal guidelines for compliance of patient clinical care

• Strong clinical acumen to thoroughly understand the patient’s health and functional status and foster effective communication

• Able to create positive impressions and communicate effectively with a variety of people and personalities

• Is an active listener and demonstrates ability to engage care team in the patient plan of care 

• Must project a professional image during virtual communication

• Ability to set up work systems and engage in flexible problem-solving behavior 

• Observant and detail oriented

• Proficient in Microsoft Office including Excel, Outlook, Power Point and Word

Physical Demands: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job with or without reasonable accommodations.

Below are minimal knowledge/physical requirements of this position.  

We’ll help you put your passion for patient care to work.  Apply today!

This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee. Duties, responsibilities and activities may change or new ones may be assigned at any time with or without notice.

We are an Equal Opportunity Employer.