Summary & Objective

The Case Manager coordinates discharge planning for   residents and/or patients and helps manage their healthcare by acting as a   liaison between the interdisciplinary team, the physicians and payor as   related to their progress and status while in the facility. The Case Manager   also assists residents and/or patients in getting access to community   resources and programs. 

Essential Functions

· Interviews   resident and/or patient and completes assessment within 72 working hours, and   documents in Medical Record. 

· Obtains   timely insurance re-certifications and provides weekly updates verbal/written   for continued stay authorization and enters into billing software. Utilizes   the Trace program when communicating with insurance representatives. 

· Attends   interdisciplinary team conference to discuss resident and/or patient status. 

· Conducts   family conference meetings as needed.

· Discharge   planning to the community with but not limited to referrals for home health   care services, ordering durable medical equipment, arranging outpatient   services referrals, referrals to Long Term Care settings, Assisted Living   Facility and Skilled Nursing Facility as applicable. 

· Educates   with patient and/or family of advanced directives if applicable 

· Educates   patient/resident and/or family on community resources and programs. 

· Coordinates   and obtains authorization from insurance company for all procedures,   appointments and transportation for all HMO residents and/or patients. 

· Communicates   with patient and/or responsible party when person served is approaching the   end of rehabilitative care status and interprets recommendations for   continuation of care.

· Provides   Important Medicare Letter of Rights to resident and/or patient and/or family   and obtains signature on form as warranted within the required timeframe   prior to discharge if applicable. 

· Provides   Notice of Medicare Non-Coverage and Nursing Home Transfer and Discharge   Notice to resident and/or responsible party and obtains signature within the   required timeframe prior to discharge if applicable.

· Follows   Medicare appeal process and keeps log as needed. 

· Completes   and posts discharge forms.

· Documents   resident and/or patient progress notes as needed.

· Serves   as a liaison with physician and continuously communicates regarding resident   and/or patient’s status and/or concerns. 

· Participates   in daily management team meetings to discuss patient and/or resident’s   status, census changes, and patient and/or resident’s complaints or concerns.   

· Conduct   follow up phone calls within 72 hours of discharge and utilized worksheet   questionnaire.  

· Obtain   HMO level increases such as IV’s (high cost drugs), special equipment and   change in skilled needs if applicable. 

· Communicate   and coordinate with third party bundle payment programs if applicable.

*Reasonable   accommodations may be made to enable individuals with disabilities to perform   the essential functions of the position.

Other Duties

· Promotes   customer service and hospitality and responds to and adequately resolves   complaints or concerns

from patient and/or   resident’s or families and informs to the Director, Case   Management/Social Services. 

· Provides orientation to new employees as needed.

· Maintain your required license, certifications and mandatory   skill updates.

· Comply with all policies, local, state and federal laws   and regulations.

· Perform   other duties as assigned.

Knowledge & Experience Requirements

· Clear   and Active Registered Nurse or Licensed Practical Nurse license to practice   in the state of Florida, Social Work or related clinical field

· CPR   certification

· 1-3   years of experience in a Health Care Facility

· Must   have knowledge of computer office/clinical software

· Must   be able to read, write and understand the English language.

Notice of AI Use in Job Application Review

As part of our commitment in creating a fair, efficient, and consistent hiring process we may use artificial intelligence (AI) to help our recruiting teams organize, summarize, and analyze information provided by candidates, including resumes, application responses, and other materials submitted during the application process.AI may be used to identify patterns, highlight relevant skills, and experience, and assist in comparing a candidate’s qualifications with the requirement of a specific role. These tools are to improve efficiency and consistency while supporting more informed hiring decisions, which will ultimately be made by the hiring team.