Case Manager/LVN - Laguna Hills Health and Rehabilitation Center

POSITION SUMMARY

 The purpose of your job position is to coordinate delivery of services to managed care and Medicare residents in accordance with current federal, state and local standards and regulations that govern the facility and in collaboration with the Administrator, Director of Marketing, and other facility staff.

The Case Manager monitors and documents the cost effectiveness of treatment provided, coordinates the admission and discharge process, serves as the resident/family advocate, and acts as liaison to insurance and medical management professionals. They will treat each resident fairly, kindly, and show them dignity and respect. They will refer to each resident by their name. They will communicate clearly, empathetically, and effectively when speaking to residents, family members, visitors, all staff and governmental agencies. They will work cooperatively with all departments and multidisciplinary teams. They will demonstrate patience, initiative and willingness to assist residents that may be difficult. They will relate all pertinent information concerning a resident’s condition to a charge nurse when required. They will be committed to always doing the right thing.

ESSENTIAL DUTIES AND RESPONSIBILITIES  

        Managing all types of insurance cases from admission through discharge

        Following up with residents’ post-discharge follow up

        Communicating by phone or in writing the resident’s status and changes in care plan to payer

        Documenting all payer interactions regarding resident progress and expected outcomes

        Maximizing benefits by coordination of cost effective care

        Meeting with facility interdisciplinary team to coordinate services and ensure total regimen of resident care is achieved

        Frequently speaking with business office and collaborating with other departments to ensure accurate census and payment of residents

        Daily review of medical records to confirm compliance with medical necessity

        Planning and organizing time and duties to efficiently maintain caseload

        Reporting any occupational exposures to blood, body fluids, or other hazardous materials to a supervisor immediately

        Protecting each residents file and data with confidentially per HIPAA standards

        Abiding with all facility policies and procedures including not disclosing user ID codes and passwords

Every effort has been made to identify the essential functions of this position. However, it in no way states or implies these are the only duties you will be required to perform as directed by management. The omission of specific statements of duties does not exclude them from the position if the work is similar, related, or is an essential function of the position.

REQUIREMENTS  

Education / Licensure  

        Completion of nursing training from accredited school or college

        Valid nurses license in good standing

        Valid CPR and BLS card

Qualifications / Experience   

        Minimum of 1 year case management experience in skilled nursing facility preferred

        Must have 5 or more years as a licensed nurse

        Excellent verbal and written skills

        Knowledge of Point Click Care helpful

Working Conditions  

        May encounter frequent interruptions

        May be involved with residents, family and government agencies

        May be requested to work beyond scheduled working hours at times

        Is subject to call‑back during emergency conditions (e.g., severe weather, evacuation, post‑disaster, etc.)

        May be necessary to assist in the evacuation of residents during emergency situations

        May be exposed to infectious waste, diseases, conditions, etc., including TB and the AIDS and Hepatitis B viruses

Physical Requirements   

        Must be able to move intermittently throughout the day

        Working throughout the nursing areas

        Repetitive hand motion

        Ability to read fine print on progress notes and/or medical labels

 *Per California state mandate, the COVID 19 vaccine is required for this position