Case Manager RN/LPN

3 days ago

MA United States Whittier Health Network Full time
Job Title: Case Manager RN/LPN

Join Whittier Health Network as a Case Manager RN/LPN and play a vital role in delivering exceptional care to our residents. As a Case Manager, you will be responsible for coordinating and overseeing the care of our patients, ensuring that their needs are met and that they receive the best possible care.

Key Responsibilities:
  • Coordinate and oversee the care of patients, including Medicare and Managed Care patients
  • Maintain communication between the interdisciplinary team, patients, and external case managers
  • Monitor documentation to ensure compliance with regulatory agency guidelines
  • Provide reimbursement specialist and resource person services
  • Participate in admission process and admission meetings, review screen referrals
  • Begin assessment of discharge planning needs on admission
  • Develop pre-admission treatment plan, including specific objectives, goals, and interventions
  • Implement and review 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
  • Coordinate, monitor, and document overall progress toward stated goals as needed
  • Communicate with patients and/or family regarding plan of care, discharge planning, and reimbursement issues
  • Communicate verbally, via telephone, in writing, and/or via fax with payor/external case managers regarding progress, changes in patient condition, and plan modifications, advocating services at an appropriate intensity to best meet patients' needs
  • Obtain authorization for continued stay
  • Obtain 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
  • Attend interdisciplinary team meetings weekly and as needed
  • Evaluate and make adjustments to the overall plan as needed
  • Attend family conferences where information relating to the status of patients' progress is discussed as needed
  • Coordinate and attend team rounds weekly
  • Coordinate through Central Supply equipment ordering/specialized mattress ordering and sign off as required
  • Communicate to billing medical records and rehab all level changes
  • Follow up on billing issues as needed
  • Conduct/attend regularly scheduled staff meetings when required
  • Coordinate services rendered by nursing personnel with those rendered by personnel of other departments
  • Accurately document all case management activities in patients' medical records
  • Review medical record documentation and monitor for compliance per facility policy and regulatory agency requirements for all departments
  • Assist in completion of MDS process, as needed
Requirements:
  • 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:
  • 401(k)
  • 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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