North Ridge Health and Rehab Cares

Character Attitude Respect Excellence Service

Our facility holds 320 beds: LTC, TCU, and Memory Care

Now offering Daily Pay! Get early access to your paycheck!

On-Site Child Daycare Center: 6 weeks to Preschool age

Perks for a Full-Time employee:

position earns a competitive salary, we also provide comprehensive benefits, including medical, dental, vision, short- and long-term disability, a flexible spending account (FSA), a 401(k) plan, paid time off (PTO), life insurance, continuing education unit (CEU) reimbursement, on-site day care at a 50% discounted rate for full time employees, refer a friend bonus between $3,000 and $6,000, pet insurance and daily pay options. PTO Roll Over Program. If this sounds like the right opportunity in health care for you, apply today!

Basic Function:
Coordinates the integration of Case Management functions into patient care, discharge, and home care planning processes with other facility departments, physicians, external service organizations, agencies, and health care facilities. Conducts concurrent medical record reviews using specific indicators and criteria as approved by Medical Staff, CMS, and other State agencies. Acts as a patient advocate, investigates and reports adverse occurrences, performs staff education related to resource utilization, discharge planning and psychosocial aspects of healthcare delivery. The Managed Care Coordinator is responsible for obtaining authorization from managed care companies and determining the level of care for all managed care patients. The Managed Care Coordinator is responsible for assessing patient/family psychosocial needs, planning, implementing, and evaluating care for patients ranging in age from 18 years to geriatric. Integrates Case Management within the facility's primary functions in a manner that contributes to the provision of comprehensive health care and achievement of quality cost effective outcomes.

Essential Functions

Resource Management/Monitoring
• Promotes effective and efficient utilization of clinical resources.
• Mobilizes resources and intervenes as necessary to achieve expected goal to assist in achieving desired clinical outcomes within the desired time frame.
• Monitors that patient tests are appropriate and necessary and are carried out within the established time frame and those results are promptly available.
• Conducts review for appropriate utilization of services from admission through discharge, evaluates patient satisfaction, and evaluates quality of care provided.
• Performs reviews for third party payers as appropriate.
• Initiates and issues "adverse determination letters" as appropriate.
• Addresses patient care required throughout continuum of care for diagnosis, procedures, and Levels of Care.
• Communicates with physicians at regular intervals throughout medical stay and develops an effective working relationship. Assists physicians to maintain appropriate cost/case and desired patient outcomes.
• Assists nursing personnel to obtain appropriate and specificity of physician documentation of diagnoses for accurate coding purposes.
• Conducts job responsibilities in accordance with the standards set out in the Company's Code of Business Conduct, its policies and procedures, the Corporate Compliance Agreement, applicable federal and state laws, and applicable professional standards.
Case Assessment/Intervention/Implementation
• Introduces self to patient and family and explains case manager role and process for patient and family. Leaves information on how to contact case manager.
• Completes assessment of patients and family needs at time of admission.
• Assesses patient's progress through expected skilled nursing course.
• Refers cases where patients and/or family would benefit from additional resource support to the Social Worker.
• Serves as a patient advocate. Enhances a collaborative relationship to maximize the patient's and family's ability to make informed decisions.
• Participates in interdisciplinary patient care rounds and/or conferences to review treatment goals, optimize resource utilization, provide family education and identified post skilled nursing needs.
• Collaborates with clinical staff in the development and execution of the plan of care, and achievement of goals.
• Participates in the development and implementation of patient care policies and protocols in order to provide advice and guidance in handling special cases or patient needs.
• Coordinates the provision of social services to patients, families, and significant others to enable them to deal with the impact of illness on individual family functioning and to achieve maximum benefits from health care services.

Discharge Planning/Coordination
• Initiates patient and family education and discharge planning prior to admission.
• Engages in individual or group counseling sessions pertaining to care and adjustment.
• Arranges for discharge and post-skilled nursing care of patients through institutions and agencies within the community.
• Assists in the development of skilled nursing policies in relation to community social agencies.
• Participates with physicians, nursing personnel, and other members of the management team in the planning of patient care services and the patient care plan.
• Coordinates the provision of information and guidance to patients, their families, and other departments regarding the psychosocial aspects of patient's post-discharge treatment and recovery programs.
• Coordinates the referral of patients and families to appropriate community, social service, home health service, extended care, and rehabilitation facilities, and organizations.
• Creates appropriate discharge plans and documents information in the medical record.
Quality Improvement/Evaluation
• Assists in identifying opportunities for improvement, participates in data collection and analysis, and contributes to problem solving and identification of actions to be taken and effectiveness of those actions.
• Develops an understanding of responsibilities for participation in QI activities. Participates in QI teams as requested.
• Assists in the development and implementation of best practices to optimize resource management to achieve desired outcomes.
• Prepares statistical reports on department services and patient needs; participates in the billing procedures for services rendered as required.
• Provides education and support to Clinical Staff by attending staff meetings, small groups, and one-on-one education related to resource utilization, discharge planning, and psychosocial aspects of healthcare delivery.
Professional Development
• Promotes self-improvement and continuing education through literature and attendance at classes/seminars that promote growth in area of specialty.
• Represents the department on various hospital committees.
• Attends mandatory in-services.
• Adheres to policies and procedures relating to safety issues, including but not limited to infection control/universal precautions.
• Participates in the Hazardous Material Program. Hazards include exposure to blood and body fluids, possible communicable disease, sharp objects and instruments, assorted chemicals and gases as listed in the Hazardous Materials Program Manual.
• Maintains all information in a manner that ensures confidentiality and meets all regulatory requirements.

JOB SPECIFICATIONS
• Current license as a Licensed Nurse in your state of practice. Certified Case Manager preferred.
• Knowledge of criteria application for skilled nursing medical necessity and appropriate level of care review.
• Ability to collect, organizes, and evaluates pertinent clinical information with effective verbal and written skills. Ability to proficiently problem-solve complex patient and family issues.
• Minimum of 2 years of Utilization Review/Case Management experience and complex discharge planning.
• Strong customer service skills and commitment to service excellence.
• Computer literacy required.