SNF Case Manager (RN) (Temecula)

The Case Manager SNF RN is responsible for the assessment, treatment planning, intervention, monitoring, evaluation and documentation for identified skilled or custodial level patients. The goal of the Inpatient SNF Case Manager is to effectively manage the patients’ SNF stay to assure the right level of care is provided and that all the patients’ medical, environmental and psychosocial needs are met, both during their stay, immediately upon discharge, and post discharge. The SNF Case Manager also coordinates patient notifications and appeals follow ups as mandated by State and Federal regulatory requirements. Essential Duties and Responsibilities In collaboration with the VP of Inpatient SNF Case Management and SNF Medical Director implement all medical management programs and processes that are consistent with the strategic, operational goals of the company. Participate in Comprehensive Care rounds as scheduled and interface with SNF Physician team for appropriate utilization/case management in conjunction with the VP Inpatient SNF Case management and SNF Medical Director. Demonstrates proficiency in all IS systems to support departmental functions including REA, Milliman Guidelines, InterQual, internet. Direct oversight of SNF cases in conjunction with SNF Medical Director and VP Inpatient SNF Case Management. Responsible for documentation including but not limited to initial admission assessment, Interdisciplinary Team meeting(s), concurrent reviews, and discharge summary on all cases assigned. Interacts with patients and families to keep all parties updated as to discharge plans and needs. Responsible for the safe discharge of patients with the necessary resources to ensure that care is provided without interruption as they transition to the next level of care. Oversee and monitor the authorization workflow process, for SNF Case Management. Maintains confidentiality of all patients and medical /clinical information per HIPAA guidelines. Reviews the SNF claim data, urgent and emergency room utilization, acute inpatient census, referrals from providers and vendors, and other appropriate data, to initiate a follow-up member assessment. Develops individualized treatment plans, as appropriate, incorporating assessment, education, resource planning, and coordination of members discharge needs including but not limited to referrals to ancillary services as identified as appropriate for all patients assigned. Training, mentoring, auditing of the clinical competency, productivity, contribution, customer service interaction of Program and Department professional and non-professional staff. Performs a liaison function for the member’s physician(s) by consistently communicating any modifications to the treatment plan to all participating disciplines and coordinates appropriate information that must be communicated to the patient and family. Performs a liaison function for member’s enrolled in a Disease Management Program, with Health Plan. Maintains documentation of individual case management plans, interventions, other statistics as needed, to demonstrate the clinical quality outcomes and cost-effective financial impact of case management. Chairs meetings, as appropriate, with the multidisciplinary team, primary care physician, and other participating personnel to update all relevant team members regarding the patient’s status and the need for any modifications to the treatment plan, as assigned by Director of Inpatient Case Management. Ability to commute to various facilities on any given day within 30 miles of the worksite office. Perform on-call duties as applicable as required. Provides coverage for colleagues on scheduled/unscheduled PTO as needed as identified. All other duties as directed by management. The pay range for this position at commencement of employment is expected to be between for LVN's $37.50 - $40 or for RN's $45 - $50 per hour; however, base pay offered may vary depending on multiple individualized factors, including market location, job-related knowledge, licensure, skills, and experience. The total compensation package for this position may also include other elements, including a sign-on bonus 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. Full-Time Position Benefits Our dedication to our staff is evident in our comprehensive benefits package. We offer a very generous mixture of benefits, including many employer-paid options. Health and Wellness Employer-paid comprehensive medical, pharmacy, and dental for employees Vision insurance Zero co-payments for employed physician office visits Flexible Spending Account (FSA) Employer-Paid Life Insurance Employee Assistance Program (EAP) Behavioral Health Services Savings and Retirement 401k Retirement Savings Plan Income Protection Insurance Other Benefits Vacation Time Company celebrations Employee Assistance Program Employee Referral Bonus Tuition Reimbursement License Renewal CEU Cost Reimbursement Program Business-casual working environment Sick days Paid holidays Mileage Employer will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of the LA City Fair Chance Initiative for Hiring Ordinance. Requirements Current CA LVN License. Current CPR certification. 3 years acute care experience. A minimum of 2-3 years of utilization or HMO experience preferred or equivalent three to five years’ experience related to case management in the acute, outpatient, home health, or managed care setting related experience and/or training; or equivalent combination of education and experience At least a minimum of 1 year of leadership experience in case management Certification in Case Management preferred. Proficient in Microsoft Office programs (i.e. Word, Excel, Access, and PowerPoint). Typing 30 WPM with accuracy. EEO is the Law #J-18808-Ljbffr