What are the responsibilities and job description for the Case Manager position at Astoria-Lake Wales?
Overview
Astoria Senior Living = Great Growth Opportunities!
Now Hiring a Case Manager!
If you are a nurse looking for a career that can make a difference, then Astoria Senior Living is the place for you. Our work family is made up of a variety of talented and committed team members who are dedicated to making a difference in the lives they serve. Each employee contributes their unique skills and abilities with the key goal of enabling our residents to reach and maintain their highest functional abilities. Every job matters at Astoria Senior Living. We believe in what we do and know our hands make a difference.
As a member of our facility, look at what benefits you can enjoy:
- Competitive starting wage with additional pay for experience
- $1,000 new employee referral program
- Paid life insurance
- 401k opportunities after your first year
- DailyPay! Work today, get paid today!
- Monthly Celebrations and recognitions
- Medical, Vision and Dental Insurance
- $5,000 Tuition Reimbursement Per Year
Responsibilities
Case Manager Primary Responsibilities
The primary purpose of this position is to communicate care requirements to the interdisciplinary team based on the clinical needs, coordinate health care benefits for all skilled residents (Medicare, Managed Care, Commercial Insurance, and other alternate payment model beneficiaries).
Organizing, managing and communicating of healthcare benefits for all residents. This includes:
- Participating in the resident care plan meetings and follow-up, as directed by Clinical Care Coordinator.
- Exhibiting working knowledge of Medicare requirements.
- Exhibiting working knowledge of insurance programs including commercial, Medicare advantage,Medicare A/B and Medicaid
- Educating the resident/families of their benefits as needed.
- Continuing communication with the interdisciplinary team and insurance providers.
- Conducting concurrent medical record review using specific indicators and criteria as approved bymedical staff, CMS and other state agencies.
- Acting as patient advocate and coordinating education related to resource utilization, discharge planningand psychosocial aspects of healthcare delivery.
- Initiating and presenting Beneficiary notices as appropriate.
- Collaborating with clinical staff in the development and execution of the plan of care and achievementof goals.
- Acting as a liaison/coordinator with insurance and other alternate payment model providers (ACOs,Bundled payments, preferred provider programs).
- Participating in daily/weekly meetings for management of Medicare/managed care residents as needed(Medicare meeting, PPS Meeting, etc).
- Assisting physicians to maintain appropriate cost, case and desired patient outcomes.
- Assisting with RAI process as indicated for updating MDS Assessments, resident interviews, and Careplan updates as related to Social Services.
Complying with safety requirements, infection control measures, and maintaining a clean work environment in accordance with facility policy as indicated by:
- Assuring that work/assignment areas are clean and records, files, etc., are properly stored before leaving such areas on breaks, end of work day, etc.;
- Abiding by all emergency protocols for crash carts, resident codes, fire safety, missing residents, tornado preparation, violent residents, Wander guard alarms, door alarms, and other facility policies as assigned;
- Reporting any forms of abuse witnessed and aware of and taking appropriate action according to policy;
- Following infection control and universal precautions procedures;
- Following periodic cleaning schedules for equipment and returning equipment to proper area after use, and
- Ensuring the facility is maintained in a clean and sanitary manner at all times.
Performing other duties as assigned by Director of Clinical Services or designee.
Qualifications
Case Manager Qualifications
Must possess specific educational and experience requirements such as:
- RN or LPN
- Preferred knowledge of the philosophy of and know the principles of the MDS and/ or Case Management processes.