Director of Case Management

Outfield Healthcare Partners -

Your Job Summary

The Director of Case Managment will be responsible for ensuring the continuity of care utilizing the appropriate resources within the parameters of established contracts and resident health plan benefits.

Facilitates continuum of patient care utilizing advanced nursing knowledge, experience and skills to ensure appropriate utilization of resources and patient quality outcomes.

Performs care management functions on-site or telephonically for assigned region.

Your Responsibilities

• Responsible for initiating the intake process, gather relevant data from referral sources and complete intake paperwork.
• Responsible for communicating efficiently with the referral source where we are in the intake process while prior authorization being obtained.
• Attains authorization for highest appropriate level of care to ensure responsible patient resource utilization and facility reimbursement.
• Alert appropriate management team members regarding late or missing documents required for data entry / prior authorization approval.
• Provide excellent customer service to patients, families, and referral sources.
• Patient’s Advocate- Coordinate and provide care that is safe, timely, effective, efficient, equitable, and client-centered.
• Establish the members PLOF upon admission.
• Ensure that members are receiving treatment from therapy department that’s clinically appropriate.
• Direct line of communication to external insurance Case Managers.
• Complete weekly update forms with current therapy progress notes, nursing documentation related to admitting diagnoses, weekly wound care assessment, eMARs and members discharge plan.
• Request and obtain continued authorization during the members skilled stay.
• Submit initial therapy evaluations to external insurance providers within 24-72 hours of admission
• Manage ALOS for all HMO members, while driving the discharge process.
• Manage the issuance of the Notice of Medicare Non-Coverage (NOMNC) process for all managed care members.
• Other duties, responsibilities and activities may change or assigned at any time with or without notice.

Your Qualifications

• Currently licensed as RN in the state practiced.
• Associate or Bachelor Degree from an accredited nursing school required.
• Minimum of five (5) years in long-term or acute health care required.
• At least two (2) years case management experience, required.
• At least two (2) years authorization experience, required.

Outfield Healthcare Partners provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.