Job Type: Full-Time
This position can work remotely but candidate must reside in Texas
Benefits Offered:
• Healthcare
• Dental
• Vision
• Paid-Time Off
Your Job Summary
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 Qualifications
• Licensed as either a Registered or Vocational Nurse.
• At least two (2) years case management experience, required.
• At least two (2) years authorization experience, required.
• Prefer at least two years of experience in Long-Term Care.
• Licensed as a Registered or Vocational Nurse or maintain a current license to practice allied health profession in Texas.
Your Job 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
• Help patients make informed decisions by acting as their advocate regarding their clinical status and treatment options.
• Other duties, responsibilities and activities may change or assigned at any time with or without notice.
OPCO Skilled Management 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.
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