District Director of Case Management
Location: Detroit Michigan
Description: Consulate Health Care is at present looking to employ District Director of Case Management right now, this job will be placed in Michigan. Detailed specification about this job opportunity kindly see the descriptions. As District Case Manager, you are delegated the administrative authority, responsibility, and accountability necessary for carrying out your assigned duties. You are r! esponsible for the training & education of the Case Manager designee. Responsible monitoring and documentation of the cost effectiveness of treatment provided, facilitates and coordinates the admission and discharge process, serves as the resident family advocate and acts as a liaison to insurance and management professionals. No supervisory function.
Communicate resident status, change in function and care plan either by phone or written report to payers TIMELY!
All duties are to assist/train facility personnel to monitor progress.
Document all payer interaction regarding resident progress, expected outcomes and reporting capabilities including special instructions.
Ensure through and timely communication with managed care/insurance case manager to coordinate certification/authorization and concurrent stay programs.
Maximize benefits by coordination of cost effective care, avoid fragmented care duplication of services and ensure the appropriate lev! el of care is provided in the most suitable setting for all fa! cilities
Meet with facility interdisciplinary team to coordinates services to ensure that the resident’s total regimen of care is maintained.
Participate in all Medicare/managed care resident interdisciplinary meetings.
Work with team members to ensure discharge-planning goals and objectives are developed and discussed at the interdisciplinary team meetings.
Assist with contract negotiations as necessary, meeting with MCO’s quarterly to improve relationship and continue open communications.
Requirements
Education
Must possess, as a minimum, a Degree in Nursing with knowledge of Managed Care Organizations and understanding of contracts.
Experience
Must have, as a minimum, Three (3) year’s experience in a hospital, nursing care facility, or other related health care facility.
Must have a working knowledge of managed care rules, regulations, and guidelines. Current relationship with MCO case managers a plus
! Specific Requirements
Must possess a current, unencumbered, active license to practice as a LPN or RN.
Must posses a demonstrated knowledge of care management; manage care, Medicare, Utilization management practices, insurance benefits and cost management strategies.
Must possess knowledge of and demonstrate competency in ensuring compliance with Medicare and third party reimbursement, criteria/levels of care.
Must have knowledge of and experience with data base application to enable use of computerized MDS systems.
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If you were eligible to this job, please email us your resume, with salary requirements and a resume to Consulate Health Care.
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This job starts available on: Sat, 11 May 2013 00:31:12 GMT