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Case Manager

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Company: Consulate Healthcare Management

Location: Lakeland, FL

Date Posted: August 14, 2014

Source: MiracleWorkers.com

Case Manager Job Description

Case Manager Summary

As a Consulate Health Care Case Manager, you are entrusted with the responsibility of caring for our residents, families, coworkers, visitors, and all others; as well as demonstrating in all interactions, Consulate Health Cares five core values of Compassion, Honesty, Integrity, Respect, and Passion. The primary purpose of your job position is to monitor and document the cost effectiveness of treatment provided, facilitates and coordinates the admission and discharges process. You are entrusted to provide innovative, responsible healthcare with the creation and implementation of new ideas and concepts that continually improve systems and processes to achieve superior results.

As case Manager, you are delegated the administrative authority, responsibility, and accountability necessary for carrying out your assigned duties. Responsible monitoring and documentation the cost effectiveness of treatment provided, facilitates and coordinates the admission and discharge process, serves as the resident family advocate and acts ...

Case Manager Job Description

Case Manager Summary

As a Consulate Health Care Case Manager, you are entrusted with the responsibility of caring for our residents, families, coworkers, visitors, and all others; as well as demonstrating in all interactions, Consulate Health Cares five core values of Compassion, Honesty, Integrity, Respect, and Passion. The primary purpose of your job position is to monitor and document the cost effectiveness of treatment provided, facilitates and coordinates the admission and discharges process. You are entrusted to provide innovative, responsible healthcare with the creation and implementation of new ideas and concepts that continually improve systems and processes to achieve superior results.

As case Manager, you are delegated the administrative authority, responsibility, and accountability necessary for carrying out your assigned duties. Responsible monitoring and documentation the cost effectiveness of treatment provided, facilitates and coordinates the admission and discharge process, serves as the resident family advocate and acts as a liaison to insure and management professional. No supervisory function. This job description does not list all the duties of the job. You may be asked by supervisor or manages to perform other duties. You will be evaluated in part based upon your performance of the tasks listed in this job description. The employer has the right to revise this job description at any time, for any reason.

Responsibilities Case Manager

Communicate resident status, change in function and care plan either by phone or written report to payers.

Include payer representative in interdisciplinary meeting if requested or deemed necessary to promote payer/provider relationship.

Document all payer interaction regarding resident progress, expected outcomes and reporting capabilities including special instructions.

Ensure through and timely communication with managed care/insurance case manager to coordinate certification and concurrent stay programs.

Maximize benefits by coordination of cost effective care, avoid fragmented care duplication of services and ensure the appropriate level of care is provided in the most suitable setting.

Meet with facility interdisciplinary team to coordinates services to ensure that the residents total regimen of care is maintained.

Participate in all Medicare and managed care resident interdisciplinary meetings.

Work with team members to ensure discharge-planning goals and objectives are developed and discussed at the interdisciplinary team meetings.

Assist in planning the services required in the residents discharge plan as necessary.

Maintain communication with facility business office and medical records to ensure accurate census and payment of managed care Medicare resident.

Perform random charting to ensure accurate and through documentation to support reimbursement of services rendered.

Meet with resident, and/or family members, as necessary. Report problem areas to department directors.

Assist with contract negotiations as necessary.

Agree not to disclose assigned user ID code and password or accessing resident/facility information and promptly report suspected or known violations of such disclosure to the Administrator.

Agree not to disclose residents protected health information and promptly report suspected or known violation of such disclosure to the Administrator.

Report any known or suspected unauthorized attempt to access facilitys information system.

Perform on-site clinical assessments of potential patients.

Assist with pre admission evaluation of potential manage care patients, including cost-cut insurance authorization and patient/insurance education as necessary.

Embrace Consulate Health Cares five core values of compassion, honesty, integrity, respect and passion, and incorporate them into ones daily job function.

Demonstrate respect and compassion in every interaction.

Conduct oneself with the highest degree of honesty and integrity in every interaction.

Demonstrate a passion for caring as evidenced by interaction with co-workers, residents, families and visitors.

May be trained and assigned to perform the customer Care Liaison duties as needed.

Perform all other duties, as assigned

Admission / Marketing Function

Participate in the admission process including pre-admission assessment, rate negotiations, benefit verification care need s and reporting.

Assist interdisciplinary team in planning for admission and ensure staff are adequately prepared to meet needs for the manage care/Medicare resident on admission.

Greet newly admitted care and Medicare residents upon admission.

Escort them to their rooms as necessary.

Participate in marketing function as deemed appropriate to assist with increasing managed care and Medicare census.

Charting and Documentation

Assist with the completion and filing of recordkeeping form/charts upon admission, transfer, and/or discharge of the managed care and Medicare resident.

Assist nursing staff in communication to physicians, transcription of orders, and documentation as requires.

Coordinate accurate and timely completion and revision of minimum data set (MDS), including the implementation of RAPs, triggers and care plans on managed care and Medicare residents. Complete assigned sections.

Ensure that assigned residents care plan accurately reflect appropriate goals, problems, approaches, and revisions based on resident needs.

Sign and date all entries made in the residents needs.

Sign and date all entries made in the residents medical records.

Personnel Function

Develop and maintain a good rapport with interdepartmental personnel, as well as other departments within the facility to ensure that services can be maintained to meet the needs of the residents.

Make appropriate reports to department supervisors as required or as may be necessary. Follow facilitys established procedures.

Report known or suspected incidents of fraud to the Administrator.

Ensure that departmental computer workstations left unattended are properly logged off or the password protected automatic screen-saver activates within established facility policy guidelines.

Nursing Care Functions

Ensure that appropriate supplies and equipment, etc., are available to meet the needs of assigned residents.

Participate in the orientation of new resident/family members to the facility.

Make rounds with physicians as necessary.

Admit, transfer, and discharge Medicare and managed care residents as required.

Budget and Planning Function

Report suspected or known incidents of fraud relative to false billings, cost reports, kickbacks, etc.

Resident Rights

Maintain the confidentiality of all resident care information. Report known or suspected incidents of unauthorized disclosure of such information.

Review complaints and grievances made by the residents and make written/oral reports to the nursing manager indicating what action (s) were taken to resolve the complaint or grievance. Follow the facilitys established procedures.

Report all allegations of residents abuse and/or misappropriation of resident property.

Miscellaneous

Provide data to the Quality Assurance Committee as requested.

Participate in facility committees as required.

Coordinate cost effective, quality care assuring that cost containment does not take precedence over quality and safety.

Participate in the development, maintenance, and implementation of the facilitys quality assurance program.

Participate in facility surveys (inspections) made by authorized government agencies as may be requested.

Job Requirements for Case Manager

Working Conditions

Work in office area (s) as well as throughout the nursing service area (i.e. drug rooms, nurses stations, resident rooms etc.)

Moves intermittently during working hours.

Is subject to frequent interruptions.

Is involved with residents, personnel, visitors, government agencies/personnel, etc., under all conditions and circumstances.

Is subject to hostile and emotionally upset residents, family members, personnel, and visitors.

Communicates with medical staff, nursing personnel, and other department directors.

Work beyond normal working hours and on weekends and holidays when necessary.

Is subject to call back during emergency conditions (e.g., server weather, evacuation, post- disaster, etc.)

Is involved in community/civic health matters/projects as appropriate.

Attends and participates in continuing educations programs.

Is subject to injury from falls, burns from equipment, odors, etc., throughout the workday, as well as reactions from dust, disinfectants, tobacco smoke, and other air contaminants.

Is subject to exposure to infectious waste, diseases, conditions, etc., including TB and AIDS and Hepatitis B viruses.

May be subject to the handling of and exposure to hazardous chemicals.

Maintains a liaison with the resident, their families, support departments, etc., to adequately plan for the residentss need.

Education

Must possess, as a minimum, a Degree in Nursing

Experience

Must have, as a minimum, Three (3) years experience in a hospital, nursing care facility, or other related health care facility.

Must have training in a rehabilitative and restorative nursing practices.

Must have a working knowledge of managed care rules, regulations, and guidelines.

Specific Requirements

Must posses a current, unencumbered, active license to practice as an RN in this state.

Must posses a demonstrated knowledge of care management; manage care, Medicare, Utilization management practices, insurance benefits and cost management strategies.

Must posses knowledge of and demonstrated competency in ensuring compliance with Medicare and third party reimbursement, criteria/levels of care.

Must have knowledge of and experience with data base application to enable use of computerized MDS systems.

Must posses demonstrated negotiation and prioritization skills.

Must have the ability to work in a matrix reporting system.

Must be a supportive team member, contribute to and be an example of teamwork and team concept.

Must be able to read, write, speak, and understand the English languages.

Must posses the ability to make independent decisions when circumstances warrant such action.

Must posses the ability to deal tactfully with personnel, residents, family members, visitors, government agencies/personnel, and the general public.

Must be knowledge of nursing and medical practices and procedures, as well as laws, regulation, and guidelines that pertain to managed care and nursing facilities.

Must posses leadership and supervisory ability and the willingness to work harmoniously with and supervise other personnel.

Must posses the ability to a plan, organize, develop, implement, and interpret the programs, goals, objectives, policies and procedures, etc., that are necessary for providing quality care.

Must have patience, tact, a cheerful disposition and enthusiasm, as well as the willingness to handle difficult residents.

Must be willing to seek out new methods and principles and be willing to incorporate them into existing nursing practices.

Must be able to relate information concerning a residents condition.

Must not pose a direct threat to the health or safety of the other individuals in the work place.

Physical and Sensor Requirements

Must be able to move intermittently throughout the workday.

Must be able to speak and write the English languages in an understandable manner.

Must be able to cope with the mental and emotional stress of the position.

Must be bale to see and hear or use prosthetics that will enable these senses to function adequately to ensure that the requirements of this position can be fully met,

Must function independently and have flexibility, personal integrity, and the ability to work effectively with residents, personnel, and support agencies.

Must meet the general health requirements set forth by the policies of the company, which include a medical and physical examination.

Must be bale to relate to and work with the ill, disabled, elderly, emotionally upset, and at times, hostile people within the facility.

Must be able to push, pull, move, and/or lift a minimum of 25 pounds to a minimum height of 5 feet and bale to push, pull, move, an/or carry such weight a minimum distance of 50 feet.

May be necessary to assist in the evacuation of residents during emergency situations.


Location: 3110OakbridgeBlvd East, Lakeland, FL 33803

Employee Type: Full-Time

Industry: Healthcare - Health Services

Manages Others:No

Job Type: Health Care
Professional Services Management

Required Education: 2 Year Degree

Required Experience: At least 3 year(s)

Required Travel: None

Relocation Covered: None

Case Manager

Requirements for Case Manager

Education

  • Must possess, as a minimum, a Degree in Nursing

Experience

  • Must have , as a minimum, Three (3) years experience in a hospital, nursing care facility, or other related health care facility.
  • Must have training in a rehabilitative and restorative nursing practices.
  • Must have a working knowledge of managed care rules, regulations, and guidelines.

Specific Requirements

  • Must possess a current, unencumbered, active license to practice as an RN in this state.
  • Must posses a demonstrated knowledge of care management; manage care, Medicare, Utilization management practices, insurance benefits and cost management strategies.
  • Must posses knowledge of and demonstrated competency in ensuring compliance with Medicare and third party reimbursement, criteria/levels of care.
  • Must have knowledge of and experience with data base application to enable use of computerized MDS systems.
  • Must posses demonstrated negotiation and prioritization skills.
  • Must have the ability to work in a matrix reporting system.
  • Must be a supportive team member, contribute to and be an example of teamwork and team concept.
  • Must be able to read, write, speak, and understand the English languages.
  • Must possess the ability to make independent decisions when circumstance warrant such action.
  • Must posses the ability to deal tactfully with personnel, residents, family members, visitors, government agencies/personnel, and the general public.
  • Must be knowledge of nursing and medical practices and procedures, as well as laws, regulation, and guidelines that pertain to managed care and nursing facilities.
  • Must posses leadership and supervisory ability and the willingness to work harmoniously with and supervise other personnel.
  • Must posses the ability to a plan, organize, develop, implement, and interpret the programs, goals,, objectives, policies and procedures, etc., that are necessary for providing quality care.
  • Must have patience, tact , a cheerful disposition and enthusiasm, as well as the willingness to handle difficult residents.
  • Must be willing to seek out new methods and principles and be willing to incorporate them into existing nursing practices.
  • Must be able to relate information concerning a residents condition.
  • Must not pose a direct threat to the health or safety of the other individuals in the work place.

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