Regional Case Manager

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Job Summary:

Job Summary:

The Regional Case Manager coordinates and facilitates the care of the patient population through effective collaboration and communication with the Interdisciplinary Care (IC) team members. Follows patients throughout the continuum of care and ensures optimum utilization of resources, service delivery and compliance with external review agencies. Provides ongoing support and expertise through comprehensive assessment, care planning, plan implementation and overall evaluation of individual patient needs. Enhances the quality of patient management and satisfaction, to promote continuity of care and cost effectiveness through the integration of functions of case management, utilization review and management, and discharge planning.

Essential Functions:

• Coordinates clinical and/or psycho-social activities with the Interdisciplinary Team and Physician/Physician Extender.
• Monitors all areas of patients stay for effective care coordination and efficient care facilitation.
• Remains current from a knowledge base perspective regarding reimbursement modalities, community resources, case management, psychosocial and legal issues that affect patients and providers of care.
• Appropriately identifies high risk patients who would benefit from additional clinical support while in the facility (RTA risk) or prior to discharge.
• Serves as a patient advocate. Enhances a collaborative relationship to maximize the patients and familys ability to make informed decisions.
• Participates in interdisciplinary patient care rounds and conferences to review treatment goals, optimize resource utilization, provide family education, and identify post SNF needs. Collaborates with clinical staff in the development and execution of the plan of care, and achievement of goals.
• Coordinates with interdisciplinary care team, physicians, patients, families, post-acute providers, payors, and others in the planning of the patients care throughout the care continuum.

Discharge Planning

• Conducts comprehensive, ongoing Nursing assessments of patients to provide timely and safe discharge planning.
• Provide comprehensive discharge planning for each patient. Utilizes critical thinking to develop and execute effective discharge planning.
• Coordinates and communicates with patient/family efficiently and effectively.

Utilization Management

• Conducts medical necessity review for appropriate utilization of services from admission through discharge.
• Promotes effective and efficient utilization of clinical resources (pharmacy, laboratory services, rehabilitation, nursing services).
• Conducts timely and accurate clinical reviews, care collaboration and coordination of continued stay authorization with payor.

Other Tasks

• Ensures timely transmission of all required documentation to the health plan, pursuant to the plans requirements.
• Communicates with external Case Managers for all Managed Care patients.
• Work collaboratively with the Central Billing Office to ensure accurate payment.

Qualifications:

• A current, valid Texas nursing license is required. Or individuals that may have specific training or education in healthcare as a licensed nurse (RN, LVN)
• CCM preferred or ability to obtained within one year based on eligibility.
• At least 2 years of managed care and case management experience preferred.
• Ability to effectively communicate, direct, and delegate tasks.
• Ability to read, write, analyze, and interpret general business periodicals, professional journals, technical procedures, or governmental regulations.
• Ability to write reports, business correspondence, nursing/resident progress notes, and nursing procedures.
• Ability to effectively present information and respond to questions from center leadership, regional leadership, and senior leadership.

We are an Equal opportunity employer; We offer an excellent benefit plan to include 401K with match, CEU reimbursement, vacation, sick, holidays, medical, dental, and supplemental insurance Plans as well as a Highly competitive compensation package.