CASE MANAGER - REGISTERED NURSE

Liberty Cares with Compassion

At Liberty Healthcare and Rehabilitation Services , we promote a challenging but rewarding opportunity in a caring environment.

We are currently seeking an experienced :

RN CASE MANAGER

JOB SUMMARY :

• Serves as a member of the health care interdisciplinary team and is the main liaison between the SNF and health plan.
• Serves as subject management expert on reimbursement contracts.
• Uses data systems to provide frequent and varied ad hoc reporting to Payer Relation Manager and assists in analyzing data for various contractual relationships.

Reviews, resolves, and evaluates escalated denial and low pay situations. Identifies trends and pursues resolution.

• Takes an independent role in auditing the reimbursement for services provided annually. Works very closely to resolve discrepancies and delinquencies.
• Completes comprehensive assessments on admission and with changes in condition. Ensures that medication carve out and levels are appropriately assigned and submitted to external partners.
• Consistently evaluates residents’ conditions and medications to determine if additional revenue is available based on external contracts.
• Submits required documentation to UM to ensure timely delivery of services and trouble shoots until authorization is obtained.

Notifies providers of successful authorization

• Provides education and support to facility staff regarding contracts and process requirements.
• Recognizes and reports adverse events and quality concerns to supervisors and Quality Management
• Schedules, coordinates and leads team conference calls with facilities as needed.
• Obtains and uploads all supporting documentation required by external providers.
• Works closely with pharmacy team on carve out and other medication requirements.
• Works with facility team on discharge planning.
• Follows up via phone interview after discharge and documents follow up on UDA in Point Click Care.
• Responsible for NaviHealth record closures.
• Escalates complex cases and cases of concern to Supervisor.
• Ensures that doctor’s orders are obtained, as applicable.

JOB REQUIREMENTS :

• Graduation from a school of nursing with valid NC licensure as a Registered Nurse and two years of full-time experience.
• Person Centered Thinking / planning
• Knowledge of using assessments to develop plans of care
• Knowledge of Diagnostic and Statistical Manual of Mental Disorders
• Proficient in Microsoft Office products (such as Word, Excel, Outlook, etc.)
• Strong interpersonal and written / verbal communication skills are essential, including conflict management and resolution skills
• High level of diplomacy and discretion is required to effectively negotiate and resolve issues with minimal assistance.
• Ability to make prompt, independent decisions based upon relevant facts

Visit www.libertycareers.com for more information.

Background checks / drug-free workplace.

EOE.

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