What are the responsibilities and job description for the SNF Case Manager- Remote position at Prestige?
Prestige -
Prestie Healthcare is looking for a Remote Part-Time SNF Case Manager!
This role pays $25 per hour!
The Case Manager (CM) plays an integral role in optimizing the plan of care for Managed Care patients. The Remote Case Manager (CM) is responsible for the timely compilation, review and submission of medical information relating to the post-acute skilled stay. By serving as the liaison between the patient, physician interdisciplinary care team members, and the payer; this position coordinates, monitors, advocates and communicates the patients progress and cost evaluation while assisting with and coordinating an efficient and smooth coordination to the next level of care.
Case Manager Responsibilities :
- Ensure Case Manager coverage is provided for each facility.
- Develop a comprehensive system to ensure clinical updates are complete and accurate before submission.
- Assess residents’ care needs and review documentation required for authorization to a Skilled Nursing Facility. Ensure documentation supports managed care / payor’s requirements.
- Ability to review and understand contract terms and requirements for Skilled Nursing Services.
- Meet submission deadlines of concurrent reviews to the managed care payor.
- Assist facilities with the determination and facilitation of discharge planning / transition of care appropriateness for the patient (Home Health, DME, NOMNC / Non-Coverage Letters).
- Communicate continued stay matters and complex cases with internal facility staff (Utilization Review Committee) and managed care payor.
- Collaborate with internal facility team (Clinical, Therapy, Social Services, Admissions, Business Office, and Billing) to facilitate protocols / outcomes for managed care patients.
- Understand, interpret, and apply managed care payor contracts for the appropriate leveling of patients for reimbursement and any carve-out / stop loss clauses. Assist corporate billing department with billing issue on behalf of patients / members.
- Provide education as needed to individual facility staff members in relation to timely submissions, documentation, etc.
- Collaborate with nurse managers and regional and corporate team members to identify specific learning UR Meeting / documentation needs of the facilities, regions, or companywide.
- Prepare, participate, and assist with Quality Assurance and Performance Improvement (QAPI) programs, projects, meetings, and training.
Case Manager Qualifications :
Salary : $25
