Case Manager
Aspire Health Group is looking for a qualified Case Manager to join our family!
We are searching for a Case Manager to join our community that is resident & family focused, a team builder, and excited about the opportunity to assist in building a facility culture.
Must be wiling to travel from Bradenton to Fort Myers and have long term/skilled nursing experience.
Benefits
• 401k with a match!
• Pay rate: Competitive.
• Access to online learning 24/7
• Health, dental, and vision insurance for the entire family and more!
Responsibilities
• Single point of Contact for Skilled and Medicaid Managed Care Case Managers.
• Primary communicator with Managed Care organization on Concurrent reviews with the goal of timely re-authorization.
• Work Collaboratively with Managed Care Point of Contacts to develop a relationship to optimize members SNF time.
• Expert on skilling criteria for each company and requirements on timing and content of updates.
• Maintains and communicates a weekly calendar of updates for each Managed Care admission.
• Reviews admissions daily.
• Identifies skilled managed care admitted without an authorization for prompt follow up.
• Assists with retro-authorizations when errors occur.
• Reviews insurance verifications to ensure authorizations were correctly obtained, head in the bed notifications are complete.
• Reviews discharges daily for skilled managed care discharges and promptly communicates.
• Work with Center & Regional team members to ensure appropriate managed care information is in place.
• Provides training to new Admission staff on Managed care process.
• Resource for team members regarding Managed Care Processes and procedures/protocols i.e., carve outs, AUTH’s, accurate payer information.
• Be responsible for physician certification of a skilled level of care throughout the Managed Care stay.
• Participate in discharge planning, training, caregiver training, and the provision of resources as needed.
• Coordinate care with case managers for residents utilizing managed care, health maintenance organizations (HMOs), commercial insurance, and other alternate payment models.
• Provide insight and analysis of Managed Care contracts.
• Serve as a member of the quality assurance and performance improvement (QAPI) committee.
• Demonstrate integrity, attention to detail, accuracy, time management skills, ability to meet deadlines, critical thinking skills, written and verbal communication skills, care plan development skills, and problem-solving skills.
• Act in compliance with Aspire Health Group regulatory and professional standards and guidelines
• Acts as the Case Manager in whatever center assigned.
• Able to travel between multiple facilities in accordance with the company’s Care travel policy.
• Extensive overnight travel may be required.
• Perform other duties, as assigned.
Qualifications
• Must have, as a minimum, three years of nursing experience in long term care/skilled nursing setting.
• Two years of Case Management experience or MDS experience preferred.
• Must possess one of following valid license.
• Registered Nurse (RN)
• Licensed Practical Nurse (LPN)
• Certified Occupation Assistant (COTA)
• Physical Therapist Assistant (PTA)
• Physical Therapist (PT)
• Occupational Therapist (OT)
• Must be knowledgeable of nursing and medical practices and procedures, as well as laws, regulations, and guidelines that pertain to nursing care facilities.
• Work effectively with individuals at all levels of the organization, as well as with residents, family members, visitors, government personnel, and the public.
• Must possess excellent communication and interpersonal skills.
• Must be a supportive team member, contribute to and be an example of teamwork and team concept.
• Plan, organize, prioritize, work independently, and meet deadlines.
We're an equal opportunity employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran, or disability status.
Hospitals and Health Care
Other
Full-time