Case Manager

PACS

About The Position

The Case Manager uses clinical expertise and critical-thinking skills to collaborate with residents, families or significant others, healthcare providers, insurers, community resources, and other involved parties. The role develops and implements plans of care that provide extraordinary care while remaining sensitive to costs and resources. The Case Manager performs clinical assessments, care planning, and direct coordination of medical services when required, and oversees admissions, discharges, referrals, and utilization review activities. This position has no supervisory responsibilities. The position is primarily sedentary, involving frequent sitting, computer use, and documentation, with regular walking throughout the facility to meet with residents, families, and staff. Occasional standing is required during meetings and care conferences, and the role may require lifting and carrying up to 20 pounds. The work environment is usually low to moderate in noise level. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Requirements

Bachelor’s degree in Nursing or Social Work.
Registered Nurse (RN) license preferred; licensed LVN or LPN is acceptable.
Knowledge of Medicare, Medi-Cal, and Medicaid programs and benefits.
Maintain all required continuing education and licensing.
Remain in good standing with the Department of Public Health, License and Certification Division.
Ability to relate positively, effectively, and appropriately with residents, families, staff, and professional colleagues.
Accurate charting and ability to complete necessary paperwork in a timely manner.
Ability to work independently and exercise sound judgment in interactions with physicians, providers, payers, residents, and families.
Ability to communicate effectively and promote cooperation and collaboration among residents, families, caretakers, physicians, nurses, and other ancillary partners.
Excellent time-management skills and ability to develop organized work processes in a high-volume environment with rapidly changing priorities.
Intermediate computer skills.
Ability to maintain professional, respectful, and honest interactions with residents, families, staff, and partners.
Clear verbal communication and vision required for chart review and resident interaction.
Ability to lift and carry up to 20 pounds.

Nice To Haves

Two years of clinical nursing experience preferred.
PCC knowledge preferred.
Certificate as a Certified Case Manager (CCM) is a plus.

Responsibilities

Communicate regularly with residents and their families about plans of care, PT, OT, and other treatment protocols.
Attend and participate in morning meetings or stand-ups to facilitate communication with the team.
Answer residents’ questions about their care, treatment plans, illness progression, and other issues so they feel safe and secure.
Monitor and adjust residents’ statuses based on changing needs and conditions.
Organize and prioritize daily work by assessing the needs of new, current, and discharging residents in the areas of responsibility.
Complete required documentation.
Perform utilization review activities to provide appropriate, timely, and cost-effective care.
Coordinate care with residents, care providers, facility financial services, and third-party payers.
Oversee admissions and discharge activities.
Coordinate referrals to and from the facility.
Perform clinical assessments, care planning, and direct coordination of medical services when required by the role.