Job Overview
Flagstone Healthcare South, LLC, is looking for an experienced Case Manager Resource. We are committed to providing excellent case management experience for our patients and an amazing work environment for our employees.
- RN, LVN, PT, OT, or SLP
- Minimum two years of case management experience in a skilled nursing facility or hospital is required
- Compensation: $95k – 150k/annually DOE
Position Overview:
This position is responsible for providing case management resources, mentoring, training and education, and case management practice guideline implementation support to facility leadership, admissions, case management, Business office, Nursing, Social Work, and facility staff to ensure we are managing patients by the terms of our contractual agreements.
This position will focus on an interdisciplinary approach with facility teams as well as market resource teams to drive education and establish better systems which will achieve the best clinical and financial results. Primary focus on managed care population; however, some areas of expertise may benefit other patient populations as well.
Goal of Position
Support and educate facility team members to best optimize our clinical and financial performance under managed care programs.
Multiplying knowledge of managed care processes across resource leadership teams as well as facility IDT teams.
Provide support to team members with focus of increasing confidence and capabilities in the managed care environment, build effective and efficient processes that achieve best possible outcomes.
Continue to expand an expertise for operating in changing healthcare environment to ultimately guide facility teams and lead to more effective processes and overall job satisfaction.
Responsibilities:
Admissions Process:
- May work with admissions departments to review assessment of prospective patients to evaluate care needs and determine suitability for admission to the program(s); understand payor systems to determine or verify coverage and funding for required patient services and length of stay.
- Train facility staff to fully comprehend payer contracts to allow them to determine appropriate reimbursement based on patient clinical needs and payor contracts; provide education or tools to assist with level negotiation and /or exclusion management.
- May work with IDT team in facilities to enhance communication from admission through patient discharge; this may include participation in facility meetings to assist with development of systems to assist with care coordination and discharge process.
- Maintain working knowledge of payer portals to support ongoing training needs with facility staff; encourage and provide assistance as needed to increase utilization of these platforms to increase efficiencies and further our partnerships with managed care payers.
Census Development:
- Partner with resource and facility teams to understand expectation of our referral sources and payer partners. Development of tools/processes to help facilities achieve optimal performance in relation to these expectations. May include partnership with multiple team members including but not limited to social services, discharge planning, case management departments, physicians, health plans, and other referral sources.
- May be involved with clinical and/or financial analysis of clinical programs to assist with program development and reimbursement under current contracts or need for contractual adjustments based on community needs.
- Communication with payers as appropriate especially with utilization management departments. May be involved with training or development of tools for facilities to ensure effective and efficient communication to our healthcare partners.
- Partner with other resources as needed to participate in JOC meetings with our managed care partners.
- May partner with other resources to communicate with referral sources as needed.
Clinical:
- Assist in identification of areas for improvement in utilization review process and/or communication to our healthcare and payer partners.
- Act as key contact for payer utilization management departments to support partnership with payers and assist with problem resolution.
- Assist in identification of where facilities may need improvement in discharge planning processes with focus on optimizing patient outcomes while managing Length of stay to payer expectations.
- Provide support and training to facility staff in collaboration with facility leadership to assist with the clinical management of the managed care population including, but limited to, utilization review, IDT meetings for clinical/financial review and discharge planning.
- Monitor performance metrics to identify areas of opportunity to further enhance payer partnerships linked to census development and financial impacts. Educate facility leadership and interdisciplinary teams regarding the importance of understanding managed care expectations and impact performance metrics have on operations….census development, payer partnerships, participation in narrowed networks, etc.
Financial:
- Utilize knowledge of all payor contracts to educate and support facility staff to ensure appropriate reimbursement for the clinical needs of our patients including, but not limited to negotiation of levels and management of exclusions.
- Partner with AR team as needed and when appropriate for special billing processes or collection issues.
- Assists with Triple check procedures as they relate to managed care patients to ensure effective communication surrounding contract level authorizations and/or exclusion management.
- Clinical/financial reviews/audits as appropriate to identify opportunities in skilled nursing.
Qualifications:
- RN, LVN, PT, OT or SLP License is required.
- Minimum two years of case management experience in a skilled nursing facility or hospital is required.
- Must be knowledgeable of nursing and medical practices and procedures
- Must possess the ability to deal tactfully with personnel, residents, family members, visitors, government agencies/personnel, and the general public.
Benefits:
- Medical, dental, vision, life insurance, FSA/HSA, EAP, and more
- 401K with Employer Match
- DailyPay
- Career advancement opportunities
- Scholarship Opportunities
- Employee discounts on entertainment events, hotels, movies, theme parks, cell phones, and much more!
EOE/Minorities/Females/Veteran/Disability
Pay: $95,000.00 - $150,000.00 per year
Benefits:
- 401(k)
- 401(k) matching
- Dental insurance
- Disability insurance
- Employee assistance program
- Flexible spending account
- Health insurance
- Health savings account
- Life insurance
- Paid time off
- Professional development assistance
- Tuition reimbursement
- Vision insurance
Application Question(s):
- Are you willing to travel throughout San Diego County 4-5 days a week?
- Does the posted compensation meet your salary expectations?
Experience:
- case management exp. in a SNF/ hospital required : 2 years (Required)
Language:
License/Certification:
- RN, LVN, PT, OT, or SLP (Required)
Ability to Commute:
- San Diego, CA 92128 (Required)
Work Location: In person
