Job description

Regional Case Manager RN or LVN

StoneGate Senior Living

Lewisville, TX

StoneGate Senior Living in Lewisville, TX is hiring a Regional Case Manager RN or LVN. A rewarding career is waiting for you at a great facility that specializes in long-term and rehabilitative care! If you are an experienced Regional Case Manager RN or LVN, we have the opportunity for you.

As the Regional Case Manager RN or LVN at StoneGate Senior Living in Lewisville, TX, is to promote quality, cost-effective interventions & outcomes for StoneGate’s managed care population. This role will collaborate with both internal customers (e.g., SNF-specific leadership teams, StoneGate administration) & external customers (e.g., patients/Responsible Parties, payors, hospital case management teams, physicians) to assess, plan, implement, coordinate, monitor, & evaluate the options to meet patients’ needs & to facilitate proper reimbursement.

The Regional Case Manager will have a modified/reduced assignment of the duties with a primary purpose of acting as a liaison between StoneGate-supported SNFs & “American Health Advantage of OK,” an institutional special needs plan (ISNP). In this liaison role, the Regional Case Manager will work to gain a comprehensive understanding of how the ISNP works including but not limited to the plan benefits for all-involved parties.

Equipped with detailed ISNP knowledge, the Regional Case Manager will provide education to applicable StoneGate-supported SNF leaders, residents &/or Responsible Parties, & StoneGate Home Office personnel regarding the program details to ensure that StoneGate is perceived as a valuable ISNP partner, that ISNP-enrolled residents are receiving benefits to which they’re entitled, & that related claims & reimbursement are being filed & processed in a compliant, timely fashion.

At StoneGate Senior Living in Lewisville, TX you will be a part of a multi-disciplinary team that is recognized for their achievements and contributions. Come be a part of our mission to provide superior clinical care, rehabilitation, wellness, and supportive services that meet the wants, needs, and expectations of our patients and residents. We offer competitive compensation, health, dental, and vision insurance, company paid life insurance, holiday pay, paid time off, employee appreciation events and much more. We look forward to you joining our team!

KEY RESPONSIBILITIES

• Assesses individual needs to develop a comprehensive case management plan collecting in-depth information of patients’ clinical status, level of function, needs, & goals.
• Coordinates with Admission team to ensure patient meets clinical criteria & has appropriate funding including obtaining initial preauthorization as back-up designee.
• Performs effective managed insurance concurrent reviews according to established guidelines & time frames utilizing clinical assessment skills/knowledge & financial resources to make decisions.
• Maintains organized correspondence system & documentation with sufficient clinical information from all relevant sources regarding case management activities &/or services.
• Maintains updated tracking log of all members in case management program assisting in outcomes measurement.
• Maintains & ensures accuracy of authorizations for all members in case management program by organizing, securing, integrating, modifying, & documenting the resources necessary to accomplish case management goals.
• Monitors cases at repeated intervals, determining the case management plan’s effectiveness in reaching desired outcomes & goals. Facilitates treatment plan modifications as warranted.
• Actively leads & participates in staff meetings, keeping departments apprised of case management activities.
• Oversees compliance with benefit verifications, Notice of Medicare Non-Coverage (NOMNC) letters, & discharge plan notifications to insurance case managers.
• Establishes & maintains professional rapport with both internal & external customers.
• Analyzes work processes & identifies areas where procedures & quality could be improved.
• Informs Director of Managed Care Reimbursement of related case management challenges for proactive & appropriate resolution.

QUALIFICATIONS:

• Requires LVN or RN with current license. An Associate’s or Bachelor’s degree in healthcare is preferable.
• Past case management experience with managed care organizations &/or SNFs is desirable.
• Requires strong verbal, written, & interpersonal communication skillset. Must embrace collaboration & teamwork.
• Requires strong organizational & critical thinking skillset.
• Requires clinical & financial acumen specific to the SNF industry.
• Strong knowledge of RAI assessment & understanding of how MDS impacts business revenue is desirable.
• Possesses the ability to teach in a one-to-one or group setting.
• Possesses essential knowledge of computers including but not limited to Microsoft Outlook, Microsoft Excel, Microsoft Word, & PowerPoint.
• Requires frequent handling of sensitive & confidential information with appropriate discretion. Must be well versed & compliant with Health Insurance Portability & Accountability Act (HIPAA) guidelines.
• Possesses a strong attention to detail.
• Demonstrates a work history of being a self-starter, working independently with minimum daily direction, & self-motivation.
• Requires regular attendance.
• Meets all local health regulations & pass post-employment physical examination, if required.
• Capable of performing the essential job functions of this job, with or without reasonable accommodations.
• Must be willing & able to travel with some overnight stays occasionally.

Job Type: Full-time

Benefits:

• 401(k)
• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Medical specialties:

• Geriatrics

Schedule:

• Monday to Friday
• Weekend availability

Work setting:

• Long term care

Experience:

• Nursing: 1 year (Required)
• Case management: 1 year (Required)

License/Certification:

• RN (Preferred)
• LVN (Preferred)

Willingness to travel:

• 75% (Required)

Work Location: On the road

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