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Job Title Case Manager
Location Anaheim, CA
Department Nursing
FLSA Status Exempt


POSITION SUMMARY 

The purpose of your job position is to coordinate delivery of services to managed care and Medicare residents in accordance with current federal, state and local standards and regulations that govern the facility and in collaboration with the Administrator, Director of Marketing, and other facility staff.

The Case Manager monitors and documents the cost effectiveness of treatment provided, coordinates the admission and discharge process, serves as the resident/family advocate, and acts as liaison to insurance and medical management professionals. They will treat each resident fairly, kindly, and show them dignity and respect. They will refer to each resident by their name. They will communicate clearly, empathetically, and effectively when speaking to residents, family members, visitors, all staff and governmental agencies. They will work cooperatively with all departments and multidisciplinary teams. They will demonstrate patience, initiative and willingness to assist residents that may be difficult. They will relate all pertinent information concerning a resident’s condition to a charge nurse when required. They will be committed to always doing the right thing.

ESSENTIAL DUTIES AND RESPONSIBILITIES

  • Managing all types of insurance cases from admission through discharge
  • Following up with residents’ post-discharge follow up
  • Communicating by phone or in writing the resident’s status and changes in care plan to payer
  • Documenting all payer interactions regarding resident progress and expected outcomes
  • Maximizing benefits by coordination of cost effective care
  • Meeting with facility interdisciplinary team to coordinate services and ensure total regimen of resident care is achieved
  • Frequently speaking with business office and collaborating with other departments to ensure accurate census and payment of residents
  • Daily review of medical records to confirm compliance with medical necessity
  • Planning and organizing time and duties to efficiently maintain caseload
  • Reporting any occupational exposures to blood, body fluids, or other hazardous materials to a supervisor immediately
  • Protecting each residents file and data with confidentially per HIPAA standards
  • Abiding with all facility policies and procedures including not disclosing user ID codes and passwords

Every effort has been made to identify the essential functions of this position. However, it in no way states or implies these are the only duties you will be required to perform as directed by management. The omission of specific statements of duties does not exclude them from the position if the work is similar, related, or is an essential function of the position.

 

REQUIREMENTS

 

Education / Licensure

Completion of nursing training from accredited school or college

Valid nurses license in good standing

Valid CPR and BLS card

 

Qualifications / Experience

Minimum of 1 year case management experience in skilled nursing facility preferred

Must have 5 or more years as a licensed nurse

Excellent verbal and written skills

Knowledge of Point Click Care helpful

 

Working Conditions

May encounter frequent interruptions

May be involved with residents, family and government agencies

May be requested to work beyond scheduled working hours at times

Is subject to call‑back during emergency conditions (e.g., severe weather, evacuation, post‑disaster, etc.)

May be necessary to assist in the evacuation of residents during emergency situations

May be exposed to infectious waste, diseases, conditions, etc., including TB and the AIDS and Hepatitis B viruses

 

Physical Requirements

Must be able to move intermittently throughout the day

Working throughout the nursing areas

Repetitive hand motion

Ability to read fine print on progress notes and/or medical labels

 


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