Case Manager, Registered Nurse/Licensed Practical Nurse
Oak Knoll Healthcare - Framingham, MA - Full Time
Case Manager, Registered Nurse/Licensed Practical Nurse - Oak Knoll Healthcare Center Full-Time, 40 hours/week - all shifts Base Pay: $40.00-48.00
Essential Duties: To provide exceptional care to all residents including but not limited to: -Coordinates and oversees each Medicare and Managed Care patient`s care from admissions through post-discharge follow-up -Maintains communication between interdisciplinary team, patient/family and external case managers from payors or other facilities. -Continuously monitors documentation to meet guidelines or standards developed by the regulatory agencies -Services as a reimbursement specialist and resource person -Participates in admission process and admission meetings, reviews screen referrals -Begins assessment of discharge planning needs on admission -Develops pre-admission treatment plan as required, to include specific objectives, goals and interventions -Implements and reviews treatment plan and length of stay in accordance with predetermined criteria. -Evaluate, assess and modify the plan as needed throughout the stay including nursing and rehab services -Coordinates, monitors and documents overall progress toward stated goals as needed -Communicates with patient and/or family regarding plan of care, discharge planning and reimbursement issues -Communicates verbally, via telephone, in writing and/or via fax with payor/external case managers regarding progress, changes in the patient condition and plan modifications, advocating services at an appropriate intensity to best meet the patients’ needs -Obtains authorization for continued stay. -Obtains authorization and approvals as needed regarding coverage for third party payors, extra-contractual services or recommended treatment plans -May coordinate and provide termination of benefits letters provided by payor/external case managers Responsible for ongoing management of discharge planning in collaboration with Social Services. -Coordinate clinical discharge summaries with nursing staff -Attends interdisciplinary team meetings weekly and as needed. -Evaluates and makes adjustments to the overall plan as needed -Attends family conferences where information relating to the status of the patients’ progress is discussed as needed -Coordinates and attends team rounds weekly -Coordinates through Central Supply equipment ordering/specialized mattress ordering and sign off as required -Communicates to billing medical records and rehab all level changes. -Follow up on billing issues as needed Conducts/attends regularly scheduled staff meetings when required -Coordinates serviced rendered by nursing personnel with those rendered by personnel of other departments -Accurately documents all case management activities in the patients’ medical record -Reviews medical record documentation and monitors for compliance per facility policy and regulatory agency requirements for all departments -Assists in completion of MDS process, as needed
Prerequisites: - Graduate of an accredited Registered Nurse school of nursing - Current and active RN OR LPN license in the state of Massachusetts - Current certification in Basic Cardiac Life Support in accordance with AHS or ARC standards - Minimum of five (5) years recent clinical experience preferably in long-term care - Effective written and verbal communication skills - Prior Utilization Review and/or Case Management experience required
Benefits available: -401k -Paid Sick -Paid Vacation -Paid Holiday -Medical -Dental -Vision -Life -Short and Long Term Disability -Hospital and Accident policy -Critical Illness -Christmas Club -Flexible Spending Accounts -Health Savings Account