Skilled Nursing Placement Team Case Manager
4 days ago
The Skilled Nursing Placement Team Case Manager plays a crucial role in facilitating the transition of patients from acute settings to skilled nursing facilities, sub-acute facilities, congregate living, and recuperative care centers. This position requires strong clinical expertise, excellent communication skills, and the ability to work effectively in a fast-paced environment.
Key Responsibilities- Facilitate patient transfers from acute settings to skilled nursing facilities, sub-acute facilities, congregate living, and recuperative care centers.
- Communicate with the After Hours Inpatient team to ensure seamless transitions.
- Conduct comprehensive reviews of clinical records, history physicals, and evaluation of skilled needs to advise on appropriate levels of care.
- Assess patient problems utilizing approved MCG guidelines and direct access to care, including skilled nursing facilities, sub-acute facilities, congregate living, and recuperative care centers.
- Follow established clinical protocols and guidelines to ensure high-quality patient care.
- Direct patients to appropriate levels of care based on assessment within established guidelines.
- Communicate with After Hours Management and escalate issues as necessary.
- Facilitate authorizations for vendors and/or outside services as appropriate.
- Document all calls according to established standards in REA/LEA.
- Document all SNF inquiries and member disposition in the SNF Placement Team log daily.
- Participate in quality monitoring processes by daily verbal endorsement between SNF Placement Team business hours and After Hours Team.
- Translate oral information into concise and accurate written documentation using standard medical guidelines and abbreviations.
- Shift summary to be sent to the Director, Manager, and Lead of SNF Department.
- Recognize financial, medical, and legal risks based on data collected during customer interactions and follow appropriate procedures.
- Demonstrate customer service-oriented behavior at all times.
- Act as a mentor as requested by supervisor.
- Expedites emergency calls as needed.
- Participate in regular staff meetings as scheduled.
- Use, protect, and disclose patients' protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards.
- Consistently exhibit behavior and communication skills that demonstrate commitment to superior customer service, including quality, care, and concern with each and every internal and external customer.
- Perform additional duties as assigned.
- Adhere to Code of Conduct.
- Graduate of an accredited nursing program.
- Registered Nurse or Licensed Vocational Nurse licensed in California.
- Current basic life support (BLS) certification.
- Minimum 3 years of clinical experience in a Skilled Nursing Facility setting.
- 1 – 2 years Case Management experience. Managed care experience preferred.
- High levels of experience or expertise in crisis intervention, teaching/coaching, disease management, and discharge planning.
Regal Medical Group offers a comprehensive benefits package, including health and wellness benefits, savings and retirement plans, and other benefits that support the well-being of our employees. We are committed to providing a supportive work environment that fosters growth and development.
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