- Work closely with the Excretive Director of Case Management and other Clinicians
- Assist with managing the day-to-day operations of the Assisted Living Waiver Program (ALW) and other Medi-Cal specialty programs as determined.
- Coordinate with the facility, members, and family on current health status, resource utilization, past and present treatment plan and services, prognosis, short and long-term goals, treatment, and provider options.
- Ensure urgency with SNF/Hospital transitions/placements.
- Determination of eligibility for enrollment in the assisted living waiver program and other Medi-Cal-funded programs
- Conducting an initial and ongoing assessment using the ALW Assessment Tool
- Determining each beneficiary's level of care (i.e., tier changes)
- Develop the Individualized Service Plan (ISP)
- Monitoring of service delivery by the RCFE/ALF and other providers.
- Maintaining progress notes and case records for each enrolled beneficiary.
- Receiving, reviewing, and responding to concerns/complaints from clients, families, or POA and forwarding all concerns/complaints to DHCS
- Reporting all signs of abuse or neglect to DHCS and the Ombudsman (if abuse or neglect occurs in an RCFE) or DHCS and APS (if abuse or neglect occurs).
- Facilitate member access to community-based services.
- Monitor referrals to community-based organizations, medical care, and other services to support the members' overall care management plan.
- Actively participate in integrated team care management rounds
- Identify related risk management quality concerns and report these scenarios to the appropriate resources.
- Oversee all case managers and social worker cases for accuracy
- Work closely with compliance on monthly file audits
- Work directly with clients/family members/facilities
- Worked closely with Star Nursing field Case Managers (CM)
- Coordinate with facility, members, and family on long-term goals, resource utilization, discharge, transition, and admissions to an approved facility.
- Identify related risk management quality concerns and report these scenarios to the appropriate resources.
- Enter, review, and maintain assessments, authorizations, and pertinent clinical information into Star Nursing management systems.
- Responsible for submissions of documentation to vendors
- Review all initial tier changes, changes in CCA's, or any other submission to DHCS to ensure 100% file compliance before submitting to DHCS.
- Participate in case management committees and work on special projects related to case management as needed.
- Expand the Star Nursing Case Management Department to include additional programs, private placement, CCT programs, and other state-funded programs and health plans.
RN Case Manager - Eureka, United States - Star Nursing, Inc.
1 month ago
Description
Job Description
Job DescriptionCase Manager– RN / Clinical Liaison
Hours: 9 am to 530 pm (PST)
Start date: ASAP
Pay rate: $65,000 to $68,000
Position: Remote – Home Base
Must have an active CA-RN license
Must have fast internet speed
Clinical Liaison / Case Manager Position:
Additional Information:
The Clinical Liaison / Case Manager is responsible for educating Medi-Cal Members and their families on the requirements of the ALWP. The Assisted Living Waiver program is designed to assist low-income seniors or adults aged 21 with a disability, providing an alternative to living at home or in a skilled nursing facility. By providing funding to move into the RCFE/ALF care setting. The clinical Liaison / Case Manager is responsible for multiple tasks during the workday. This position requires a licensed RN with a minimum of one year of current experience in the case of management, long-term care, skilled nursing, sub-acute care, post-acute care, assisted living, and hospital settings. Experience working with discharge planners and social services departments would be helpful. This Clinical Liaison / Case Manager will work directly with case managers and discharge planners to process Assisted Living Waiver referrals, Health plans, and other specialty programs rapidly and promptly. Must have experience with a high-volume workload. This is a work-from-home position, with the flexibility to do monthly visits with a caseload of residents residing in ALF/RCFEs.
Company DescriptionStar Nursing is a Joint Commission Certified healthcare staffing agency with thousands of nationwide opportunities. Travel, direct hire, and temporary positions available, highest rates in the industry