We are seeking a dynamic RN Case Manager to join our growing team.
The Case Manager has a unique opportunity to help us take APDs Case Management Program to the next level. Be a part of program development and strategic initiatives that will make a difference for our patients and organization. This position will provide opportunity for professional growth and has potential for developing into a managerial position.POSITION SUMMARY:This position is responsible for the development, implementation, and daily operations of the case management program at Alice Peck Day Health Systems. Primary Responsibilities include: ensuring optimal utilization of our Med Surg and Skilled Nursing Facility (SNF) beds, ensuring that we provide the appropriate amount and level of care, and that APDHS receives appropriate re-reimbursement for care provided based on objective care guidelines.POSITION EXPECTATIONS:-Provides direct case management services to patients to ensure appropriate level and amount of care is provided in the most appropriate setting, while optimizing reimbursement for care we provide.-Provide clinical review, utilization review and admission decision on all referrals to SWING and SNF level of care.-Coordinate admissions process to include use of e-Discharge and designate admission location with internal stakeholders on Med/Surg and ECF.-Maintain effective communication with health care team members related to ongoing care delivery, utilization management and discharge planning.-Coordinate and facilitate daily admissions meeting for interdisciplinary review of referrals and determination of appropriate setting. Case Manager will direct decisions of utilization review as needed.-Monitors daily census and informs administration of trends and/or problems.-Completes and/or partners with Patient Access and Director of Re-reimbursement and Contracts to attain pre-certifications from, and negotiating with commercial payers.-Attend and participate in all interdisciplinary patient care rounds for Med/Surg.-Advise on appropriate length of stay and resource maximization in partnership with interdisciplinary team and patient accounting personnel.-Provide concurrent review and follow up with appropriate personnel regarding denials. Partners with business office regarding denials and appeals process.-Collect and provide data trending and analysis regarding utilization management, denials, maximization of resources, and inform on capacity to improve re-reimbursement to Medical Staff, Quality Improvement Team and Administration.-Develop and maintain policies complaint with Federal and state regulations and with Case Management standards of practice.-Develop policies and protocols to ensure best practice and compliance with CMS regulations.-Participate as indicated in care plan meetings, ECF QI Team meetings, Patient Care Committee and other committees as appropriate.- Develops and maintains liaisons with local and state resources and partner organizations.Qualified candidates will have: current NH RN license; 3-5 years of case management or utilization review experience; Bachelors Degree in a related field; understanding of financial reimbursement; experience in program development; ability to work in a self-directed role and make clear decisions; ability to build a maintain effective working relationships.