Neighborhood Nurse Director/ Medicare Case Manager
Job Summary
This position provides care to assigned residents in a caring, safe and efficient manner and is responsible to perform the following according to location standards, procedures and individualized resident care plans.
Receives referrals, conducts analysis of resident’s needs, ensures appropriateness of admission according to payer source and quality care; oversees fiscal management of the payer revenue/expenses from admission through discharge. Assures residents, families and / or significant others are aware of current payment system requirements and guidelines. Provides residents with opportunities for independence and choice consistent with their care plans. Directs and assists with staff resident, family/significant other education regarding payer system issues. Serves as vital link to all Medicare team members and other disciplines to ensure delivery of resident benefits under the specific payer plan. Stays updated on current payment issues, interpretations and RAI/MDS updates; receives and shares information. Establishes appropriate payer system documentation guidelines. Directs and documents care provided to residents. Functions as the main contact between payer and resident and family; communicates regular updates on resident progress and outcomes. Participates in Admission-Transfer Discharge Team. Uses the EMR accurately.
Qualifications
(Nursing (RN) and medical) knowledge required; graduate of an accredited school of nursing. licensure, registration or certification for state of practice is required; case management certification desirable; a Master Social Worker (MSW) with previous managed care case management and medical social work experience may meet the qualifications.
Ability to perform critical analysis of clinical issues to extrapolate necessary data and information to develop accurate costing and effective critical pathways / care planning to ensure quality resident outcomes.
Basic ability to communicate and comprehend; ability to measure and comprehend certain quantities; knowledge of health care payer systems including managed care and Medicare eligibility and coverage requirements; knowledge and familiarity with the therapeutic effects and side effects of all medications administered; sound clinical (Nursing (RN) and medical) knowledge required.
The Good Samaritan Society offers an attractive, employee-approved benefits package for qualifying employees. The variety of benefits include: health benefits, a retirement plan, work/life balance benefits, voluntary benefits and much more! To review all of the great benefits and benefit eligibility, visit: https://www.good-sam.com/jobs/benefits
This position must be an RN who will be in charge of Rehab-Skilled care as well as Neighborhood Director.
All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sexual orientation, gender identity, national origin, citizenship, age, disability, veteran status, genetic information, marital status or other protected status. For more information including state-specific protections, please visit: https://www.good-sam.com/lp/careers/eeo-and-affirmative-action