Nurse Case Manager

Advantage Living Wayne , MI 48184

Posted 5 months ago

Overview

The Nurse Case Manager is responsible to develop relationships with referring hospitals and medical referral sources in conjunction with the Admissions Director to achieve budgeted census goals established by the facility. The Nurse Case Manager conducts onsite visits at hospitals to assess potential new residents, visit facility residents temporarily in the hospital, and connect with discharge planners to identify additional patients for referral to the facility.

Qualifications

  • Currently licensed as an LPN or RN in the state of Michigan.

  • At least three years of marketing, case management or similar background required

  • Excellent assessment, organization and coordination skills

  • Current driver's license and car. Ability to travel within the service area without limitations. Ability to travel at least 80% of working hours.

  • Knowledge of regulatory standards and compliance requirements related to healthcare marketing required.

  • Excellent customer service skills including positive written and verbal communication skills essential with the ability to establish and maintain rapport with clients and referral sources.

  • Working knowledge of personal computer and software applications used in job functions, (word processing, graphics, databases, spreadsheets, etc.).

  • Strong organizational and analytical skills;

  • Demonstrated ability in independent functioning and strong leadership.

  • Excellent written and verbal communication skills. Excellent interpersonal skills.

  • Ability to work well with an interdisciplinary team and health care providers.

Essential Functions and Responsibilities

Advantage Living Centers expects their employees to promote an atmosphere of teamwork, exemplify the values of CARING (Compassion, Accountability, Respect, Integrity, Nimbleness and Generosity and uphold the pursuit of creating a person-centered culture for Residents and Team Members. To perform this job successfully, an individual must also be able to perform each key function satisfactorily. Reasonable accommodations may be made to enable individuals with disabilities to perform the key functions.

  • Conducts hospital visits daily to onsite potential new residents, visit facility residents in a temporary hospital stay and connect with hospital discharge planners to identify potential referrals.

  • Acts as a back- up for the Admission Director and/or Admission Coordinator for referrals.

  • Responds timely and decisively to referrals and escalates referrals as needed for clinical and financial approvals.

  • Reviews potential admissions and identifies clinical needs of residents to identify costs, acuity needs and facility capabilities to successfully care for the resident.

  • Utilizes available resources to cost out potential admissions to determine facility ability to manage the resident's full care needs within anticipated reimbursement level.

  • Negotiates initial rates with Insurance companies to assure residents are assigned appropriate Care Levels and the facility is reimbursed at the proper rates.

  • Works with hospital case managers and discharge planners to successfully place residents in assigned facility and communicates medical and equipment needs to the facility in preparation for admission.

  • In the absence of the Admission Director or Admission Coordinator, escalates financial approvals to the Administrator or Regional Director of Operations.

  • Participates in and ensures contracts are signed prior to or at the time of admission.

  • Develops, coordinates and nurtures relationships with potential referral sources including hospital, post-acute, community, physician, insurance company and other resources through external marketing efforts.

  • Participates in external marketing activities with internal and corporate staff to develop facility specialties, embed assigned facility in the community, and create relationships with managed care and discharge planners to become a resource and post-acute provider of choice.

  • Attends weekly marketing meetings, and offers insight into the needs of hospitals, doctors and residents. Actively contributes innovation suggestions for improved marketing outcomes.

  • Identifies and communicates insurance contracts needed to increase access to referrals.

  • Develops strategies to maximize admissions of patients requiring a sub-acute level of care including daily contact with potential referral sources (hospitals, physicians, insurers, case management companies and health care agencies).

  • Participates in the development of a culture of census.

  • Coordinates clinically complex patient admissions.

  • Attends hospital collaborative meetings and coordinates facility attendance of key community and hospital meetings.

  • Responsible for internal physician engagement, including monitoring physician assignments upon admission and ongoing outreach to physicians to solicit feedback on quality care, outcomes, and other needs.

  • Coordinates care needs with referral source and communicates with the facility Admission Coordinators equipment and services required for a smooth transition are available prior to or soon after the resident's expected admission.

  • Responds to Patient Ping, when available, and actively follows up with information received.

  • Gives report to nursing staff regarding the status and needs of newly admitted residents.

  • Communicates with and educates referral sources regarding service via written and telephone contact.

  • Prepares reports for the leadership team as requested.

  • Participates in quality improvement programs.

  • Updates referral resources on status of patients currently receiving service or recently discharged and the patient' response to services received when appropriate

  • Keeps current with changes and trends in the market.

  • Ensures growth and profitability of the company through the responsible use of company resources.

  • Accepts other assignments as appropriate.

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Nurse Case Manager

Advantage Living