SNF Case Manager

SNF Case Manager

The SNF Case Manager oversees utilization and care coordination for patients in contracted Skilled Nursing Facilities. The role focuses on reducing unnecessary SNF length of stay, facilitating goals-of-care discussions, coordinating safe discharge placement, and improving concurrent review documentation to support appropriate post-acute utilization.

This position collaborates closely with Acute and Outpatient Case Management teams, physicians, and families to ensure patients receive goal-concordant care and transition to the most appropriate level of care as soon as clinically appropriate.

Key Responsibilities:

• Conduct concurrent case reviews.
• Monitor rehabilitation progress and medical necessity.
• Identify prolonged or low-benefit SNF stays and escalates as needed.
• Work with SNF teams to establish expected discharge timelines.

Goals of Care:

• Identify patients with limited rehabilitation potential or advanced illness.
• Facilitate goals-of-care discussions with patients, families, and providers.
• Support appropriate transitions to palliative care or hospice.

Discharge Planning:

• Coordinate discharge to the most appropriate setting (home, assisted living, long-term care, or hospice).
• Address barriers to discharge including caregiver support, equipment, or services.

Documentation & Concurrent Review:

• Ensure documentation supports continued SNF stay.
• Identify gaps in clinical documentation and work with SNF teams to improve accuracy.

Care Coordination:

• Participate in SNF interdisciplinary care meetings.
• Serve as liaison between SNFs, physicians, hospitals, and the medical group.

Adherence to Policies:

• Promote organizational goals.
• Know and follow Employee Handbook and all other company Policies and Procedures Manual(s).
• Communicate verbally and in writing through proper channels.
• Adhere to all Compliance Regulations including, HIPAA, Fraud, Waste, and Abuse, Harassment, Code of Conduct, Model of Care, Cultural and Linguistics, and Injury and Illness.
• Participate in mandatory meetings, as required.
• Adhere to all company policies including attendance and dress code.

Performance Metrics:

• Reduced SNF length of stay
• Increased appropriate hospice/palliative transitions.
• Timely goals-of-care discussions
• Improved concurrent review documentation.
• Reduced SNF-to-hospital readmissions
• Increased discharges to home or lower levels of care

Compliance Statement:

This position requires that the Employee abide by the Company's Compliance Plan (including its Standards of Conduct) and all Compliance Policies and Procedures (as listed on the Company's Intranets or Internet pages under Compliance). This position further requires the Employee to act with the highest standards of integrity and professional ethics. This would include but is not limited to the expectation and requirement that the Employee immediately report any potential Compliance, Security or Privacy, or potential Fraud?Waste?Abuse violations or issues to the Company's Compliance Officer, Compliance Hotline, and/or to any Officer of the Company.

The pay range for this position at commencement of employment is expected to be between $33.00 and $36.00/hour; however, base pay offered may vary depending on multiple individualized factors, including market location, job-related knowledge, skills, and experience. The total compensation package for this position may also include other elements, and discretionary awards in addition to a full range of medical, financial, and/or other benefits (including 401(k) eligibility and various paid time off benefits, such as vacation, sick time, and parental leave), dependent on the position offered. Details of participation in these benefit plans will be provided if an employee receives an offer of employment.

If hired, employee will be in an "at-will position" and the Company reserves the right to modify base salary (as well as any other discretionary payment or compensation program) at any time, including for reasons related to individual performance, Company or individual department/team performance, and market factors.

Required Qualifications:

• Licensed Vocational Nurse (LVN) or Licensed Clinical Social Worker (LCSW)
• Active California license
• 3+ years' experience in SNF care coordination, case management, or post-acute care
• Must be computer literate.
• Excellent written, verbal, and interpersonal communication skills. Bilingual preferred.
• Ability to handle and prioritize tasks in order to meet all given deadlines and productivity goals.
• Ability to responsibly manage matters of a confidential nature.
• Ability to work in a multi-task, high-productive and fast paced environment.
• Preferred experience in value-based or risk-bearing healthcare organizations.
• Preferred experience with hospice, palliative care, or utilization review.