Accel at Willowbend is actively searching for a Case Manager to promote quality and cost effective interventions and outcomes for the Managed Care population. This role will collaborate with the treatment team, administration, payors, and patients to assess, plan, implement, coordinate, monitor and evaluate the options to meet patient’s needs and facilitate proper reimbursement.
The Key Responsibilities
- Assesses individual needs in order to develop a comprehensive case management plan collecting in-depth information of patients’ clinical status, needs and intervention, and level of function.
- Coordinates with admission team to ensure patient meets clinical criteria and has appropriate funding including obtaining initial preauthorization.
- Performs effective concurrent review according to established guidelines and time frames utilizing clinical assessment skills/knowledge and financial resources to make decisions.
- Maintains organized correspondence system with sufficient clinical information from all relevant sources and its documentation regarding case management activities and/or services.
- Maintains updated tracking log of all members in case management program assisting in outcomes measurement.
- Maintains and ensures accuracy of authorizations for all members in case management program organizing, securing, integrating, modifying and documenting the resources necessary to accomplish case management goals
- Accurately documents in the case management activity record specific case management activities and/or interventions that lead to accomplishing goals.
- Monitors cases at repeated intervals determining the case management plan’s effectiveness in reaching desired outcomes and goals and facilitates plan modifications as indicated to treatment plan.
- Actively participates in staff meetings and keeps departments apprised of case management activities including providing support to staff for patient’s services as needed.
- Oversees compliance with benefit verification, NOMNC, and discharge plan notification to insurance case manager including forwarding of pertinent files, forms/information to appropriate staff.
- Establishes and maintains professional rapport with insurance providers, patients, staff and referral sources.
- Analyzes work processes and identifies areas where procedures and quality could be improved.
- Informs Administrator/DON of out-of-network insurance cases and/or unusual cases or situations.
- Requires current RN license in state of Texa
- Prefers Case Management experience/Managed Care Payor system
- Requires strong verbal and written communications skills, interpersonal skills, and teamwork
- Requires strong organizational and critical thinking skill
- Requires financial/clinical acume
- SNF/LTC experience preferre
- High volume admission/discharge experience preferre
- Strong knowledge in RAI assessment and understanding of MDS, how it impacts business revenu
- Possesses the ability to teach in one to one or group setting
- Other duties as assigned