Top 29 Clinical case managers Jobs in Pleasanton, Tx

Skilled Nursing Facility (SNF) Case Manager
Hunters Pond Rehabilitation and Healthcare Center —San Antonio, TX
- From $60,000 a year
- Full-time
- Background check
- Nursing
- Skilled nursing facility
- Health savings account
- Disability insurance
Quick Apply
6d
1099 Child & Adolescent Therapist (Texas)
Fort Health —Texas
- $85 an hour
- 8 hour shift
- Remote
- LMFT
- Psychiatry
- Licensed Clinical Social Worker
- Flexible schedule
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Case Manager II, Youth Mental Health Services, Pos. #275, Corpus Christi, TX
Nueces County MHMR Community Center —Texas
- $22.20 an hour
- Full-time
- Nursing
- Clean driving record
- Computer literacy
- Mileage reimbursement
- Loan repayment program
5d
Casemanager I - MH ONLY
Camino Real Community Services —Jourdanton, TX
- $50,053 a year
- Full-time
- Nursing
- Surgery
- RN License
- Flexible schedule
11d
Peer Support Specialist
Camino Real Community Services —Jourdanton, TX
- Up to $18.84 an hour
- High school diploma or GED
- Communication skills
- Entry level
RN Case Manager - PRN
Heart to Heart Hospice —Pleasanton, TX
- PRN
- Nursing
- RN License
- Mid-level
- Mileage reimbursement
- Paid holidays
Quick Apply
COMPLEX CARE MANAGER
The Center for Health Care Services —San Antonio, TX
- $61,870.67 - $65,657.54 a year
- Weekends as needed
- Background check
- Spanish
- Writing skills
1d
Registered Nurse (RN) - Case Manager
Adaptive Home Health —Somerset, TX
- $60 per point
- Weekends as needed
- RN License
- BLS Certification
- Mid-level
- Health insurance
- Dental insurance
Quick Apply
Registered Nurse (RN)
Adaptive Home Health —Somerset, TX
- $55 - $60 an hour
- Weekends as needed
- RN License
- BLS Certification
- Mid-level
- Health insurance
- Dental insurance
Quick Apply
Case Manager II, Jail COC, MHA, Pos. #561, Corpus Christi, TX
Nueces County MHMR Community Center —Texas
- $22.20 an hour
- Full-time
- Spanish
- Nursing
- Clean driving record
- Mileage reimbursement
- Loan repayment program
Case Manager II, ACT, MHA, Pos. #125, Corpus Christi, TX
Nueces County MHMR Community Center —Texas
- $22.98 an hour
- Full-time
- Clean driving record
- Computer literacy
- Adults
- Mileage reimbursement
- Loan repayment program
Case Manager II, Coordinated Specialty Care, MHA, Pos. #504, Corpus Christi, TX
Nueces County MHMR Community Center —Texas
- $22.20 an hour
- Full-time
- Clean driving record
- Computer literacy
- Mid-level
- Mileage reimbursement
- Loan repayment program
Licensed Specialist in School Psychology
Floresville ISD —Floresville, TX
- $58,722 - $84,501 a year
- Online Application
- School experience
- Mid-level
- Psychology
Quick Apply
Police Psychologist
City of San Antonio —San Antonio, TX
- $85,896.20 - $128,844.30 a year
- Full-time
- Background check
- Computer literacy
- Mid-level
- Disability insurance
- Health insurance
8d

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Skilled Nursing Facility (SNF) Case Manager

Hunters Pond Rehabilitation and Healthcare Center -
San Antonio, TX

Quick Apply

Job Details

Full-time
From $60,000 a year
6 days ago

Benefits

Health savings account
Disability insurance
Health insurance
401(k)
Employee assistance program
Vision insurance
Gym membership
Life insurance

Qualifications

Teamwork
Bachelor's degree
Clinical documentation
Negotiation
Time management

Full Job Description

Overview

The Skilled Nursing Facility (SNF) Case Manager is responsible for coordinating resident care, managing payer requirements, facilitating interdisciplinary communication, and ensuring appropriate utilization of healthcare resources throughout the resident's stay. This role serves as a liaison between residents, families, healthcare providers, managed care organizations, and facility departments to promote optimal clinical and patient outcomes.

The SNF Case Manager plays a critical role in admission management, payer authorization, Interdisciplinary care coordination, length-of-stay management, discharge planning, and care transition coordination while supporting resident-centered care.

Essential Duties and Responsibilities

Admissions and Authorization Management

Review referrals and clinical documentation to determine appropriateness for SNF admission.
Coordinate pre-admission assessments and payer eligibility verification.
Obtain and manage insurance authorizations for Medicare Advantage, Managed Care, Commercial, and other payer sources.
Collaborate with hospital discharge planners, physicians, and referral sources to facilitate and streamline care transition to SNF.
Ensure timely communication with payers regarding clinical updates and authorization requests.

Clinical Reimbursement and Care Coordination

Lead and coordinate resident care planning activities with the interdisciplinary team.
Participate in daily clinical meetings, utilization reviews, and care conferences.
Monitor resident progress toward established goals and discharge plans.
Identify barriers to care and implement interventions to improve outcomes.
Facilitate communication among residents, families, physicians, therapists, nursing staff, and managed care companies.
Section GG and PDPM Leadership
Serve as the clinical champion and facilitator for initial and discharge Section GG function score meetings.
Drive interdisciplinary collaboration between nursing, therapy, and MDS to ensure precise, accurate, and compliant functional scoring that reflects true patient care needs.

Utilization and Length of Stay Management

Monitor resident length of stay and utilization of services.
Conduct concurrent reviews to ensure medical necessity and continued skilled coverage.
Submit clinical updates and supporting documentation to managed care companies.
Track authorization expirations and ensure uninterrupted coverage.
Analyze payer trends and identify opportunities to optimize reimbursement and resident outcomes.
Utilization Defense: Utilize objective clinical and functional data to build robust clinical justifications for continued skilled stay, effectively communicating functional deficits to managed care payers during concurrent reviews.
Peer-to-Peer and Appeals Managements: Must have the clinical acumen to assist prepping the Medical Director for peer-to-peer reviews and execute expedited appeals when a managed care organization issues an inappropriate discharge.

Discharge Planning and Care Transitions

· Initiate discharge planning upon admission with IDT by identifying anticipated discharge needs, barriers, caregiver support, equipment requirements, and community resources.

· Coordinate safe and effective transitions to home, assisted living, long-term care, or other settings.

· Arrange community resources, durable medical equipment, home health services, and follow-up appointments.

· Educate residents and families regarding discharge expectations and available resources.

· Monitor readmission risks and implement strategies to reduce avoidable hospitalizations.

Regulatory and Compliance Responsibilities

Maintain compliance with CMS, Medicare, Medicaid, state regulations, and managed care requirements.
Maintain comprehensive case management documentation supporting medical necessity payer communications, authorization determinations, discharge planning activities, and care coordination efforts.
Participate in audits, surveys, and quality improvement initiatives.
Maintain confidentiality and comply with HIPAA regulations.

Quality and Performance Management

Monitor key performance indicators including:
Average Length of Stay (ALOS)
Readmission Rates
Authorization Denial Rates
Managed Care Performance Metrics
Discharge-to-Community Outcomes
Quality Measures Outcomes
Participate in process improvement initiatives to enhance resident care and operational performance.
Support facility goals related to quality measures and value-based care programs.

Qualifications

Education and Licensure

Licensed Vocational Nurse (LVN/LPN) or Registered Nurse (RN)

Experience and Knowledge

Minimum of 2 years of experience in Skilled Nursing Facility operations, case management, managed care, discharge planning, or utilization review.
Experience with Medicare Advantage and Managed Care plans preferred.
Knowledge of post-acute care regulations and reimbursement methodologies.

· Required: Advanced knowledge of the Patient Driven Payment Model (PDPM), specifically Section GG functional scoring.

· Familiarity with Texas HHSC regulations and PASRR requirements.

Certifications (Preferred)

Certified Case Manager (CCM)
Accredited Case Manager (ACM)
Care Coordination and Transition Management (CCTM)
MDS Certification RAC-CT preferred

Knowledge, Skills, and Abilities

Strong understanding of Managed Care and post-acute reimbursement systems.
Knowledge of SNF clinical operations and interdisciplinary care planning.
Excellent communication, negotiation, and relationship management skills.
Ability to analyze clinical information and determine medical necessity.
Strong organizational and time management skills.
Proficiency with electronic medical records and case management software.
Ability to manage multiple priorities in a fast-paced healthcare environment.
Knowledge of discharge planning, utilization review, and care transition processes.

Key Performance Expectations

The SNF Case Manager will be accountable for:

Timely payer authorizations and reauthorizations.
Effective management of resident length of stay.
Reduction of avoidable hospital readmissions.
Successful discharge-to-community outcomes.
Compliance with payer and regulatory requirements.
Collaboration with the interdisciplinary team to achieve clinical and financial goals.
Optimization of managed care and Medicare reimbursement opportunities.

Reporting Structure

Reports To: Administrator

Works Closely With:

Administrator
Director of Nursing
MDS Coordinator
Therapy Department
Medical Director
Social Services
Admissions Team
Managed Care Organizations
Hospital Case Managers and Discharge Planners

FLSA Status: Exempt

Position Type: Full-Time

This position is integral to achieving exceptional resident outcomes, successful care transitions, regulatory compliance, and strong managed care performance within the Skilled Nursing Facility.

Pay: From $60,000.00 per year

Benefits:

401(k)
Disability insurance
Employee assistance program
Gym membership
Health insurance
Health savings account
Life insurance
Vision insurance

Work Location: In person

Quick Apply

Refine Your Search

clinical case managers jobs in pleasanton, tx

Skilled Nursing Facility (SNF) Case Manager

1099 Child & Adolescent Therapist (Texas)

Case Manager II, Youth Mental Health Services, Pos. #275, Corpus Christi, TX

Casemanager I - MH ONLY

Peer Support Specialist

RN Case Manager - PRN

COMPLEX CARE MANAGER

Registered Nurse (RN) - Case Manager

Registered Nurse (RN)

Case Manager II, Jail COC, MHA, Pos. #561, Corpus Christi, TX

Case Manager II, ACT, MHA, Pos. #125, Corpus Christi, TX

Case Manager II, Coordinated Specialty Care, MHA, Pos. #504, Corpus Christi, TX

Licensed Specialist in School Psychology

Police Psychologist

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