Case Manager

General Purpose

• Utilize clinical expertise and critical thinking skills to work collaboratively with residents, resident family/significant other, healthcare providers, insurers, community resources and other involved parties to develop and implement a plan of care that provides extraordinary care for the patient while being sensitive to costs and resources.

Essential Responsibilities

• Communicate regularly with residents and their family about Plans of Care, PT, OT and other treatment protocols.
• Attends and participates in morning meetings/stand up to facilitate communications with the team.
• Answer residents' questions about their care, treatment plans, illness progression and all other issues so they feel safe and secure in our care.
• Monitor and adjust residents' statuses based on changing needs and conditions.
• Organize and prioritize daily work by assessing new, current and discharging residents' needs in the area(s) of responsibility.
• Complete documentation as required.
• Performs utilization review activities to provide resident appropriate, timely and cost-effective care.
• Coordinate care with resident, care providers, facilities financial services, and third-party payers.
• Oversee all admissions and discharge activities.
• Coordinate referrals both to and from our facility.
• Ability to relate positively, effectively, and appropriately with residents, families, staff and professionals
• colleagues.
• Accurate charting and ability to complete necessary paperwork in a timely manner.
• Ability to work independently and exercise sound judgement in interactions with physicians, providers, payers and residents and their families.
• Must be able to effectively communicate with, and promote cooperation and collaboration between individuals including residents/families/caretakers, physicians, nurses and other ancillary partners.
• Must have excellent time management skills to develop organized work processes in a high-volume environment with rapidly changing priorities.
• Intermediate computer skills.
• Competence in maintaining professional, respectful, honest interactions with residents/families and staff and partners.
• Perform clinical assessments, care planning, and direct coordination of medical services when required by the role

Supervisory Requirements

This position has no supervisory responsibilities.

Qualification

Education and/or Experience

• Bachelor's Degree in Nursing or Social Work. Registered Nurse (RN) license preferred. Licensed (LVN or LPN) nurse acceptable.
• Two (2) years of clinical nursing experience preferred.
• Knowledge of Medicare, Medi-cal and Medicaid programs and benefits.
• PCC Knowledge preferred.
• Certificate as a certified Case Manager (CCM) a plus.
• Must maintain all required continuing education/licensing.
• Must remain in good standing with the Department of Public Health, License and Certification Division at all times.

Physical Demands

• Primarily sedentary with frequent sitting, computer use, and documentation.
• Regular walking throughout the facility to meet with residents, families, and staff.
• Occasional standing during meetings and care conferences.
• Ability to lift and carry up to 20 pounds (files, binders, supplies).
• Clear verbal communication and vision required for chart review and resident interaction.

Work Environment

The noise level in the work environment is usually low to moderate.