Genesis Healthcare LLC Anaheim , CA 92808
1.Works with assigned managers to ensure Case Management Staff has skills, training, tools and support to handle the responsibility of managing Managed Care patient plan of care and plan requirements.
2.Intervenes on behalf of Managed Care patient with plan to minimize operational variation in handling patients and to negotiate better Level of Care, Rates, and Length of Stay.
3.Identifies process improvement opportunities and communicates to Sr. Director, Case Management for discussion with Managed Care Plans, Centers, Managed Care Services Business Development, and/or Divisional Team.
4.Produces/Shares outcomes to ensure exceptional level of service provided by Case Management Staff to Areas, Regions, and Centers achieves expectations.
5.Manages the daily operations of the Case Management System -- process, staff, technology, and performance - to meet the requirements of the managed care reimbursement model.
6.Ensures quick acceptance of Managed Care cases by monitoring efficiency of Benefit Verification and Pre-Certification processes in Point Click Care/EMR
7.Monitors outcomes to promote sound management practices, quality care, and a sound financial position. Participates in identification and implementation of performance improvement solutions.
8.Assists staff to secure from plans authorizations exclusions defined by contract or exception approvals for high cost medications and/or equipment. Assure exclusions are properly documented in Collections Module and communication provided to vendor when billing plan directly.
9.Accountable for all human resource functions of management, per diem, and dedicated staff. Assists to hire, supervise, and train direct reports as needed. Identifies staff training and professional development needs and provides appropriate guidance. Conducts performance reviews.
10. Collaborates with the Managed Care and divisional Business Development teams in identifying strategies for census development and program improvements.
11. Collaborates with Managed Care Business Development to build, maintain and strengthen relationships with Managed Care Plans within assigned territory upon request.
12. Serves as a consultant to Center and all regional teams regarding Managed Care Case Management.
13. As requested by Senior Director, may participate in the development of annual strategic plan and budget for scope of responsibility.
14. Monitors issues and tracks inquiries to assure timely, accurate closure; identifies trends and improvement opportunities. Reports to Sr. Director, Case Management recommendations for plan-related process improvement
15. Provides customer support and excellent customer service
16. Promotes the Genesis Network both internally and externally.
EDUCATIONAL REQUIREMENTS: 1. Graduate of an accredited School of Nursing with current LPN or RN licensure in the state where employment occurs is required.
Bachelor-s Degree in Nursing preferred. Certified Case Management (CCM) or related clinical certification also preferred.2. Seven or more years of recent clinical nursing experience required.
Prior experience in utilization review, case management or discharge planning required.3. Prior experience using evidence-based clinical decision support criteria4. Experience in rehabilitation nursing, acute care and/or the insurance field preferred.
Five years full time experience in case management which includes service to short/long term facility based clients preferred.5. Minimum five years management experience. Remote staff supervision preferred6. Valid driver-s license and automobile with appropriate insurance required.
Position Type: Full Time
Req ID: 288310
Center Name: Anaheim Terrace Care Center