Nurse Assistant NAR

Avalon Care Center At Northpointe • Spokane, WA

324d • $45 - $55

About The Position

Avalon Healthcare Tacoma is now hiring a Case Manager to join our team! The Case Manager will be responsible for facilitating interdisciplinary plans and assuring progress reports are completed and provided to payor as required; Also serves as liaison between patient, physician, care team members, payor, and the discharge planner by coordinating, monitoring, and communicating patient's progress and cost evaluation and assisting with coordination to the next level of care.

Requirements

• Nursing background strongly preferred
• Associate degree in the health & human service field preferred
• Current, active, and unrestricted licensure or certification in a health or human services discipline preferred
• Minimum two (2) years' experience in medical case management preferred
• Comprehensive knowledge of workers' compensation, insurance, and managed care required
• Ability to negotiate coverage and provide complete and timely case management reports required
• Prior experience with an insurance company, private case management company, or HMO preferred
• Familiarity with long-term care and/or sub-acute care useful
• Strong oral and written communication skills required

Responsibilities

• Obtain prior authorizations
• Negotiate appropriate level of care within contract terms with the payor case manager
• Utilize Letter of Agreement for non-contracted arrangements
• Communicate information to care team and coordinate patient's smooth transition to the next level of care
• Obtain accurate information from physicians, patient, and payor source regarding the expected discharge plan and communicate this information to the interdisciplinary team
• Develop referrals from hospitals' social service and discharge planning departments, physicians, case managers, insurance companies and other referral sources
• Participate in Marketing Action Plan and Key Account Meetings and assume Key Account Management responsibilities as directed by their supervisor
• Visit hospital social workers, physicians, hospital discharge planners and administrators, attorneys, support organizations (i.e., oncology, stroke, head injury, etc.) civic/professional organizations, etc. to understand the need for program services and to communicate services offered which meet these needs to obtain referrals of patients
• Invite referral sources to nursing center and present programs and presentations to support groups, insurance companies, self-insured industry, physicians, etc.
• Network through case management organizations by attending community meetings regularly
• Act as a liaison between payors and decision makers facilitating a smooth transfer of information
• Assist in program evaluation as requested
• Maintain primary focus of census development and revenue enhancement
• Provide documentation of contract or payor information on a timely basis to treatment team and business office billing staff, following case management policies
• Monitor that records pulled for insurance provider requests are complete and appropriate

Benefits

• 401K
• Medical, Dental & Vision
• FSA & Dependent Care FSA
• Life Insurance
• AD&D, Long Term Disability, Short Term Disability
• Critical Illness, Accident, Hospital Indemnity
• Legal Benefits, Identity Theft Protection
• Pet Insurance and Auto/Home Insurance

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Industry: Nursing and Residential Care Facilities
• Education Level: Associate degree