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Posted: Tuesday, October 17, 2017 7:30 AM

Purpose of Your Job Position As a Consulate Health Care Case Manager, you are entrusted with the responsibility of caring for our residents, families, co:workers, visitors and all others; as well as demonstrating in all interactions, Consulate Health CareA?s five core values of Compassion, Honesty, Integrity, Respect and Passion. The primary purpose of your job position is to influence/management the cost effectiveness of treatment and ancillary services through an intimate relationship with therapy and nursing. You will be involved in the care of all managed care patients starting at pre:admission and continuing through payment for services provided. You are entrusted to provide innovative, responsible healthcare with the creation and implementation of new ideas and concepts that continually improve systems and processes to achieve superior results. Job Functions As Case Manager, you are delegated the administrative authority, responsibility, and accountability necessary for carrying out your assigned duties. Responsible for monitoring and documenting the cost effectiveness of treatment provided, facilitates and coordinates the admission and discharge process, serves as the resident family advocate and acts as a liaison to insurance and management professionals. No supervisory function. This job description does not list all the duties of the job. You may be asked by supervisors or managers to perform other duties. You will be evaluated in part based upon your performance of the tasks listed in this job description. The employer has the rightto revise this job description at any time, for any reason. Duties and Responsibilities 1. Participate in the admission process including pre:admission assessment, rate negotiations, benefit verification, care needs and reporting.2. Communicate resident status, change in function and care plan either by phone or written report to payers.3. Include payer representative in interdisciplinary meeting if requested or deemed necessary to promote payer/provider relationship.4. Document all payer interactions regarding resident progress, expected outcomes and reporting capabilities including special instructions.5. Ensures thorough and timely communication with managed care/insurance case managers to coordinate certification and concurrent stay programs.6. Assist with the completion of the MDS for managed care patients.7. Negotiate all one:time payer agreements and LOAA?s with the assistance of the Executive Director, District Director of Case Management, and Vice President of Managed Care and Professional Services.8. Coordinate all services for each managed care patient, including in home and outside of the care center.9. Approves all payer changes affiliated with managed care patients.10. Reviews all ancillary invoices with Executive Director and Business Office Manager.11. Key communicator of discharge plans related to managed care patients.12. Review and challenge documentation before sending to MCO.13. Maximize benefits by coordination of cost effective care, avoid fragmented care, duplication of services and ensure the appropriate level of care is provided in the most suitable setting.14. Meet with facility interdisciplinary team to coordinate services to ensure that the residentA?s total regimen of care is maintained.15. Participate in all Medicare and managed care resident interdisciplinary meetings.16. Perform clinical assessments.17. Work with team members to ensure discharge:planning goals and objectives are developed and discussed at the interdisciplinary team meetings.18. Assist in planning the services required in the residentA?s discharge plan as necessary.19. Maintain communication with facility business office and medical records to ensure accurate census and payment of managed care and Medicare residents.20. Perform random chart reviews to ensure accurate and thorough documentation to support reimbursement of services rendered.21. Meet with residents, and/or family members, as nec

Source: https://www.tiptopjob.com/jobs/72600202_job.asp?source=backpage


• Location: Gainesville

• Post ID: 18824262 gainesville
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