RN Care Mgr – Post Acute (Skilled Nursing Facilities)

Essential Functions

  • Reviews patients’ clinical records within 24 hours of admission Mon-Fri and 72 hours after weekend SNF admission
  • Conducts prospective, concurrent, and retrospective review of active patient care on-site or telephonic, where assigned
  • Reviews patient referrals within the specified CM policy time frame. (Request Types and Timeline Policy)
  • Coordinates treatment plans, discharge expectations, and when applicable, discusses DPA and DNR status with Nurse Practitioner or attending physician
  • Prioritizes patient care needs. Meets with patient, patient’s family, and caregivers as warranted to discuss care and treatment plan
  • Coordinates provisions for discharge from facilities, including follow up appointments, home health, social services, transportation, etc., in order to maintain continuity of care
  • Communicates authorization/denial for services to appropriate parties. Communication may include patient (or agent), attending/referring physician, facility administration, and Tandigm claims as necessary
  • Educates patients and/or families about preventive care, medical issues, and use of prescribed medical treatments and/or medications
  • Collaborates with other clinical and administrative staff in a positive, constructive manner
  • Demonstrates a thorough understanding of the cost consequences resulting from Care Management decisions through utilization of appropriate reports: Health Plan Eligibility and benefits, Bed Days, etc.
  • Ensures appropriate utilization of medical facilities and services within the parameters of the patient’s benefits and/or Care Management policies. This includes appropriate and timely movement of the patient through the various levels of care
  • Initiates and/or oversees data entry into IS systems on all patients within 24 hours of patient contact. Maintains accurate and complete documentation of care rendered including LOC, CPT code, ICD 10, referral type, date, and etc.
  • Demonstrates flexibility when performing assignments in order to meet organization and client (Tandigm) goals
  • Demonstrates, by action and attitude, the standard of high patient satisfaction, treating each patient with respect
  • Demonstrates, by action and attitude, the standard of high staff and physician satisfaction, treating staff and physicians with respect
  • Participates actively in regularly scheduled team meetings, including daily care team meetings within assigned facilities and attends continuing medical education (CME) programs as needed
  • Meet all facility requirements and bylaws for Nursing Staff
  • Meet all Tandigm provider credentialing and QI standards
  • Uses, protects, and discloses Tandigm patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards
  • Assumes other Care Management duties as delegated
  • Performs additional duties as assigned

Education & Experience

  • Current RN license in Pennsylvania & graduation from an accredited school of nursing (BSN preferred) with;
  • At least one year of recent clinical experience (3-5 years preferred)
  • Must have valid driver’s license and insurance. Must be able to travel within the five county Philadelphia, PA region as needed. Must also be able to attend on-site meetings at Tandigm’s corporate headquarters on a weekly basis
  • Previous care management, utilization review, or discharge planning experience preferred (HMO experience preferred)

Knowledge, Skills, Abilities

  • Excellent fund of knowledge with respect to the practice of medicine;
  • Commitment to service excellence and patient satisfaction;
  • Knowledge of current standards of patient care and thorough understanding of RN scope of practice;
  • Able to make sound, independent judgments, and act professionally under pressure;
  • Skills in establishing and maintaining effective working relationships with other teammates, patients and the general public;
  • Ability to speak with patients and assess health needs in a compassionate manner;
  • Able to quickly analyze, comprehend and create written/verbal clinical and business communication and documentation;
  • Ability to multi-task in a fast-paced clinical setting
  • Must possess excellent verbal, written and interpersonal communication skills
  • Ability to relate to culturally diverse patients and community
  • Ability to develop positive interaction with patients, families, physicians, administrators and teammates in order to effectively care for the patient
  • Computer proficiency
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