Case Manager, Registered Nurse/Licensed Practical Nurse

Company: Whittier Health Network
Location: Framingham
Posted on: September 4, 2024

Job Description:

Case Manager, Registered Nurse/Licensed Practical Nurse - Oak Knoll Healthcare CenterFull-Time, 40 hours/week - all shiftsBase Pay: $40.00-48.00Essential 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 neededPrerequisites:- 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 requiredBenefits 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 AccountziEx25h2thby Jobble

Keywords: Whittier Health Network, Framingham , Case Manager, Registered Nurse/Licensed Practical Nurse, Executive , Framingham, Massachusetts