Case Manager

$75,000 - $90,000/Yr

Luxe At Wellington Rehabilitation Center The - Wellington, FL

Full-time - Mid Level

Wellington, FL

About the position

The Case Manager (CM) at Luxe at Wellington Rehabilitation Center plays a crucial role in optimizing care plans for Managed Care patients. This position involves coordinating and advocating for patients' needs while ensuring compliance with managed care requirements. The CM serves as a liaison among patients, physicians, and interdisciplinary care teams, facilitating smooth transitions to the next level of care.

Responsibilities

• Ensure Case Manager coverage is provided for the facility.
• Develop a comprehensive system to ensure clinical updates are complete and accurate before submission.
• Assess residents' care needs and review documentation required for authorization to a Skilled Nursing Facility.
• Ensure documentation supports managed care/payor's requirements (InterQual and Milliman Care Guidelines).
• Review and understand contract terms and requirements for Skilled Nursing Services.
• Meet submission deadlines of concurrent reviews to the managed care payor.
• Assist facilities with discharge planning and transition of care appropriateness for the patient.
• Communicate continued stay matters and complex cases with internal facility staff and managed care payor.
• Collaborate with internal facility team to facilitate protocols/outcomes for managed care patients.
• Understand, interpret, and apply managed care payor contracts for appropriate patient leveling for reimbursement.
• Assist corporate billing department with billing issues on behalf of patients/members.
• Provide education to facility staff regarding timely submissions and documentation.
• Collaborate with nurse managers and corporate team members to identify learning needs of the facilities.
• Prepare, participate, and assist with Quality Assurance and Performance Improvement (QAPI) programs.

Requirements

• Must have an active license (LPN/RN/Therapist).
• Substantial work experience relevant to case management, care planning, discharge planning, and clinical chart reviews.
• Work experience in post-acute care, skilled nursing facilities, long-term care, or assisted living.
• Demonstrated leadership and supervisory skills in case management and employee relations management.
• Basic knowledge of nursing and medical practices and procedures, as well as state and federal regulations specific to nursing home operation and licensure.
• Ability to plan, organize, develop, implement, and interpret programs, goals, objectives, policies, and procedures necessary for providing quality individualized care.
• Ability to formulate reports, disseminate information, interpret data, and coordinate with multiple departments.

Nice-to-haves

• Experience in supervising staff in a healthcare setting.
• Familiarity with managed care contracts and reimbursement processes.

Benefits

• Competitive Compensation
• Great Benefits Package
• Engaging Work Atmosphere
• Innovative Training Programs
• Excellent Growth Opportunities