Case Manager

Overview

Come join us as The Case Manager at Oak Hill Senior Living to make a difference! 

If you are looking for a career that can make a difference, then Oak Hill Senior Living is the place for you. Our work family is made up of a variety of talented and committed team members who are dedicated to making a difference in the lives they serve. Each employee contributes their unique skills and abilities with the key goal of enabling our residents to reach and maintain their highest functional abilities. Every job matters at Oak Hill Senior Living. We believe in what we do and know our hands make a difference.

As a member of our nursing team, look at what benefits you can enjoy:

• Competitive starting wage with additional pay for experience
• $1,000 new employee referral program
• Paid life insurance
• 401k opportunities after your first year
• DailyPay! Work today, get paid today!
• Monthly Celebrations and recognitions
• $5,000 Tuition Reimbursement Per Year 

Responsibilities

The primary responsibility of the Case Manager is to communicate care requirements to the interdisciplinary team based on the clinical needs, coordinate health care benefits for all skilled residents (Medicare, Managed Care, Commercial Insurance, and other alternate payment model beneficiaries).

Organizing, managing and communicating of health-care benefits for all residents. This includes:

• Participating in the resident care plan meetings and follow-up, as directed by Clinical Care Coordinator.
• Exhibiting working knowledge of Medicare requirements.
• Exhibiting working knowledge of insurance programs including commercial, Medicare advantage, Medicare A/B and Medicaid
• Educating the resident/families of their benefits as needed.
• Continuing communication with the interdisciplinary team and insurance providers.
• Conducting concurrent medical record review using specific indicators and criteria as approved by medical staff, CMS and other state agencies.
• Acting as patient advocate and coordinating education related to resource utilization, discharge planning and psychosocial aspects of health-care delivery.
• Initiating and presenting Beneficiary notices as appropriate.
• Collaborating with clinical staff in the development and execution of the plan of care and achievement of goals.
• Acting as a liaison/coordinator with insurance and other alternate payment model providers (ACOs, bundled payments, preferred provider programs).
• Participating in daily/weekly meetings for management of Medicare/managed care residents as needed (Medicare meeting, PPS Meeting, etc).
• Assisting physicians to maintain appropriate cost, case and desired patient outcomes.
• Assisting with RAI process as indicated for updating MDS Assessments, resident interviews, and Care plan updates as related to Social Services.

Qualifications

Case Manager Requirements/Qualifications

• A high school diploma or GED.
• Preferred knowledge of the philosophy of and know the principles of the MDS and/or Case Management processes
• Experience working with different types of insurances