Consulate Health Care Divisional Director of Case Management - Consulate Health Care - Maitland in Maitland, Florida
Job ID 38030
Position Location US-FL-Maitland
Alternate Position Location Florida
Facility Name Consulate Health Care - Maitland
Job Category MDS
Position Status FT (Full Time)
Purpose of Your Job Position
As a Consulate Health Care District Director of Case Management, you are entrusted with the responsibility of carrying out your daily tasks and assigned duties while demonstrating Consulate’s Core Values of Compassion, Honesty, Integrity, Respect and Passion. You are expected to provide innovative, responsible results with the creation and implementation of new ideas and concepts that continually improve systems and processes to achieve superior results. The primary purposes of your job position are to monitor and document the cost effectiveness of treatment provided and facilitates and coordinate the admission and discharge process.
As District Director of Case Management, you are delegated the administrative authority, responsibility, and accountability necessary for carrying out your assigned duties. You are responsible for the training & education of the Case Manager designee and for monitoring and documenting the cost effectiveness of facilities managed care contract management with a goal of lowering cost and increasing revenue. This position is a non-supervisory function. This job description does not list all the duties of the job. You may be asked by supervisors or managers to perform other duties. You will be evaluated in part based upon your performance of the tasks listed in this job description. The employer has the right to revise this job description at any time, for any reason.
Duties and Responsibilities
1) Assist, train and monitor progress of Case Manager designees in the following aspects of facilities managed care contract management:
Document all payer interactions regarding resident progress, expected outcomes and reporting capabilities including special instructions.
Ensures thorough and timely communication with managed care/insurance case managers to coordinate certification and concurrent stay programs.
Maximize benefits by coordination of cost effective care, avoid fragmented care and duplication of services, and ensure the appropriate level of care is provided in the most suitable setting.
Meet with facility interdisciplinary team to coordinate services to ensure that the resident’s total regimen of care is maintained.
Participate in all Medicare and 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 in planning the services required in the resident’s discharge plan as necessary.
Maintain communication with facility business office and CBO to ensure accurate census and payment of managed care and Medicare residents.
Perform random charting review to ensure accurate and thorough documentation to support reimbursement of services rendered.
Assist with contract negotiations, as necessary.
Agree not to disclose assigned user ID code and password for accessing resident/facility information and promptly report suspected or known violations of such disclosure to the Administrator.
Agree not to disclose resident’s protected health information and promptly report suspected or known violations of such disclosure to the Administrator.
Report any known or suspected unauthorized attempts to access facility’s information system.
Assist with pre admission evaluations of potential managed care patients, including cost-out, insurance authorization, and patient/insurance education for training purposes, as necessary.
2) Have understanding of Regions Managed Care contracts.
3) Embrace Consulate Health Care’s five core values of compassion, honesty, integrity, respect and passion, and incorporate them into one’s daily job function.
4) Demonstrate respect and compassion in every interaction.
5) Conduct oneself with the highest degree of honesty and integrity in every interaction.
6) Demonstrate a passion for caring as evidenced by interaction with co- workers, residents, families and visitors.
7) Perform all other duties, as assigned.
Assist/train facility Case Manager Designees.
Assist and participate in the admission process including pre-admission assessment, rate negotiations, benefit verification, care needs, and reporting.
Assist interdisciplinary team in planning for admission and ensure staff is adequately prepared to meet needs for the managed care resident on admission.
Develop and maintain a good rapport with interdepartmental personnel, as well as other departments within the facility to ensure that services can be maintained to meet the needs of the residents.
Make appropriate reports to department supervisors as required or as may be necessary. Follow facility’s established procedures.
Report known or suspected incidents of fraud to the Administrator.
Ensure that departmental computer workstations left unattended are properly logged off or the password protected automatic screen-saver activates within established facility policy guidelines.
Budget and Planning Functions
- Report suspected or known incidences of fraud relative to false billings, cost reports, kickbacks, etc.
Maintain the confidentiality of all resident care information. Report known or suspected incidents of unauthorized disclosure of such information.
Review complaints and grievances made by residents and make written/oral report to the nursing manager indicating what action(s) were taken to resolve the complaint or grievance. Follow the facility’s established procedures.
Report all allegations of resident abuse and/or misappropriation of resident property.
Provide data to the Quality Assurance Committee as requested.
Participate in facility committees as required.
Coordinate cost effective, quality care assuring that cost containment does not take precedence over quality and safety.
Participate in the development, maintenance, and implementation of the facility’s quality assurance program.
Participate in facility surveys (inspections) made by authorized government agencies as may be requested.
- Must possess, as a minimum, a Degree in Nursing.
Must have, as a minimum, three (3) year’s experience in a hospital, nursing care facility, or other related health care facility.
Must have training in a rehabilitative and restorative nursing practices.
Must have a working knowledge of managed care rules, regulations, and guidelines.
Must possess a current, unencumbered, active license to practice as an RN/LPN in this state.
Must possess a demonstrated knowledge of care management; managed 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 possess demonstrated negotiation and prioritization skills.
Must have the ability to work in a matrix reporting system.
Must be a supportive team member, contribute to and be an example of teamwork and team concept.
Must be able to read, write, speak, and understand the English language.
Must possess the ability to make independent decisions when circumstances warrant such action.
Must possess the ability to deal tactfully with personnel, residents, family members, visitors, government agencies/personnel, and the general public.
Must be knowledgeable of nursing and medical practices and procedures, as well as laws, regulations, and guidelines that pertain to managed care and nursing facilities.
Must possess leadership and supervisory ability and the willingness to work harmoniously with and supervise other personnel.
Must possess the ability to plan, organize, develop, implement, and interpret the programs, goals, objectives, policies and procedures, etc., that are necessary for providing quality care.
Must have patience, tact, a cheerful disposition and enthusiasm, as well as the willingness to handle difficult residents.
Must be willing to seek out new methods and principles and be willing to incorporate them into existing nursing practices.
Must be able to relate information concerning a resident’s condition.
Must not pose a direct threat to the health or safety of other individuals in the work place.
Where Will Compassion Take You?
At Consulate Health Care, we're looking for talented, compassionate and hard-working individuals who are eager to serve others. Our team members go above and beyond to give our residents and patients the care they deserve — so you'll find that every day with Consulate Health Care offers new and exciting opportunities to learn and grow.
Compassionate hearts and passionate dedication – these two qualities shine in our team members and provide the foundation for our mission of “Providing Service With Our Hearts and Hands” . The compassion you'll show to residents, patients and their families is the lifeline of our business, while relationships with your peers and coworkers will strengthen our vibrant, diverse community.
Consulate Health Care is one of the nation's leading providers of Senior healthcare services, specializing in post-acute care. Operating in 21 states, we offer services ranging from short-term transitional care to Alzheimer’s and dementia care.
24-hour skilled nursing care
Comprehensive post-acute care
Physical, Occupational and Speech therapies
"Your Journey Home" short-term rehab program
Alzheimer's and dementia care
Care for medically-complex patients