Case Manager, Registered Nurse/Licensed Practical Nurse

2 months ago

Framingham, United States Whittier Health Network Full time
Case Manager, Registered Nurse/Licensed Practical Nurse - Oak Knoll Healthcare Center
Full-Time, 40 hours/week - all shifts
Base Pay: $40.00-48.00

Essential Duties: To provide exceptional care to all residents including but not limited to:
-Coordinates and oversees each Medicare and Managed Care patient`s care from admissions through post-discharge follow-up
-Maintains communication between interdisciplinary team, patient/family and external case managers from payors or other facilities.
-Continuously monitors documentation to meet guidelines or standards developed by the regulatory agencies
-Services as a reimbursement specialist and resource person
-Participates in admission process and admission meetings, reviews screen referrals
-Begins assessment of discharge planning needs on admission
-Develops pre-admission treatment plan as required, to include specific objectives, goals and interventions
-Implements and reviews treatment plan and length of stay in accordance with predetermined criteria.
-Evaluate, assess and modify the plan as needed throughout the stay including nursing and rehab services
-Coordinates, monitors and documents overall progress toward stated goals as needed
-Communicates with patient and/or family regarding plan of care, discharge planning and reimbursement issues
-Communicates verbally, via telephone, in writing and/or via fax with payor/external case managers regarding progress, changes in the patient condition and plan modifications, advocating services at an appropriate intensity to best meet the patients’ needs
-Obtains authorization for continued stay.
-Obtains authorization and approvals as needed regarding coverage for third party payors, extra-contractual services or recommended treatment plans
-May coordinate and provide termination of benefits letters provided by payor/external case managers Responsible for ongoing management of discharge planning in collaboration with Social Services.
-Coordinate clinical discharge summaries with nursing staff
-Attends interdisciplinary team meetings weekly and as needed.
-Evaluates and makes adjustments to the overall plan as needed
-Attends family conferences where information relating to the status of the patients’ progress is discussed as needed
-Coordinates and attends team rounds weekly
-Coordinates through Central Supply equipment ordering/specialized mattress ordering and sign off as required
-Communicates to billing medical records and rehab all level changes.
-Follow up on billing issues as needed Conducts/attends regularly scheduled staff meetings when required
-Coordinates serviced rendered by nursing personnel with those rendered by personnel of other departments
-Accurately documents all case management activities in the patients’ medical record
-Reviews medical record documentation and monitors for compliance per facility policy and regulatory agency requirements for all departments
-Assists in completion of MDS process, as needed

Prerequisites:
- Graduate of an accredited Registered Nurse school of nursing
- Current and active RN OR LPN license in the state of Massachusetts
- Current certification in Basic Cardiac Life Support in accordance with AHS or ARC standards
- Minimum of five (5) years recent clinical experience preferably in long-term care
- Effective written and verbal communication skills
- Prior Utilization Review and/or Case Management experience required

Benefits available:
-401k
-Paid Sick
-Paid Vacation
-Paid Holiday
-Medical
-Dental
-Vision
-Life
-Short and Long Term Disability
-Hospital and Accident policy
-Critical Illness
-Christmas Club
-Flexible Spending Accounts
-Health Savings Account
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