Case Manager / Clinical Care Coordinator Hayward, CA
We have a new employment opportunity for a Case Manager / Clinical Care Coordinator in a nursing facility located in Hayward, California. The Clinical Care Coordinator provides Medicare, Managed Medi-Cal/Medicaid and Managed Care/Insurance oversight to ensure appropriate clinical services are provided and optimal reimbursement is received.
The Clinical Care Coordinator ensures that all departments provide collaborative resident care and advocates on behalf of the patient and facility for needed patient resources and services within the reimbursement continuum.
Clinical Care Coordinator responsibilities:
• Ensures facility’s compliance with Medicare regulations, Managed Care/Insurance contracts and Company guidelines, policies and procedures.
• Ensures that each resident receives superior care in a manner that maintains or enhances their quality of life and helps them attain and maintain the highest possible mental and physical functional status, in an environment of kindness, dignity and respect.
• Makes certain that residents’ rights are well established and protected at all times; fair and equitable treatment, self-determination, individuality, privacy, property and civil rights, including the right to voice complaints.
• Utilizes resource stewardship, using safe and cost effective protocols in an efficient manner to minimize waste.
• Consults with the resident’s physician in providing care, treatment, rehabilitation, etc., as necessary.
• Greets newly admitted managed care residents within 24 hours of admission. Participates in the orientation of new residents/family members to the facility.
• Ensures thorough and timely communication with managed care/insurance case managers to coordinate certification and concurrent stay programs.
• Communicates resident status, change in function and care plan either by phone or written report to payers.
• Completes regular chart reviews to assess the quality of the documentation to support skilled Medicare and medical necessity Managed Medi-Cal /Medicaid and Managed Care/Insurance coverage. Documents pertinent narrative data to support clinical care and services.
• Collaborates with Social Services to ensure safe transitional/discharge plans are initiated upon admission and updated as indicated.
• Works with Business Office staff to ensure Medicare Part A services are appropriately billed and meet Medicare documentation guidelines.
Clinical Care Coordinator qualifications:
• Nursing degree from accredited college or graduation from approved RN or LVN program as well as current, unencumbered license to practice as an RN or LVN required.
• Previous Case Management or MDS experience and/or 5 years’ nursing experience preferred
• Strong clinical skills and previous experience in Long Term Care environment highly desirable
• Current valid CPR certification required
• Proficiency with Electronic Medical Records required; familiarity with Point Click Care preferred.
Compensation will be generous, and will be based upon professional experience.
Executive Search Solutions is a national healthcare recruitment firm with a focus on long-term care. Our clients include Skilled Nursing Facilities (SNF)/ Nursing Homes, Assisted Living and Independent Living centers, Continuing Care Retirement Communities (CCRC), Rehab, Hospice, Acute Care Hospitals, and Home Health Agencies.
Please call David Van Matre at 760-699-7671 for more information, fax resume to 877-685-8779, or email resume to dvanmatre@essusa.net to be considered for this position. We look forward to hearing from you.
We have a new employment opportunity for a Case Manager / Clinical Care Coordinator in a nursing facility located in Hayward, California. The Clinical Care Coordinator provides Medicare, Managed Medi-Cal/Medicaid and Managed Care/Insurance oversight to ensure appropriate clinical services are provided and optimal reimbursement is received.
The Clinical Care Coordinator ensures that all departments provide collaborative resident care and advocates on behalf of the patient and facility for needed patient resources and services within the reimbursement continuum.
Clinical Care Coordinator responsibilities:
• Ensures facility’s compliance with Medicare regulations, Managed Care/Insurance contracts and Company guidelines, policies and procedures.
• Ensures that each resident receives superior care in a manner that maintains or enhances their quality of life and helps them attain and maintain the highest possible mental and physical functional status, in an environment of kindness, dignity and respect.
• Makes certain that residents’ rights are well established and protected at all times; fair and equitable treatment, self-determination, individuality, privacy, property and civil rights, including the right to voice complaints.
• Utilizes resource stewardship, using safe and cost effective protocols in an efficient manner to minimize waste.
• Consults with the resident’s physician in providing care, treatment, rehabilitation, etc., as necessary.
• Greets newly admitted managed care residents within 24 hours of admission. Participates in the orientation of new residents/family members to the facility.
• Ensures thorough and timely communication with managed care/insurance case managers to coordinate certification and concurrent stay programs.
• Communicates resident status, change in function and care plan either by phone or written report to payers.
• Completes regular chart reviews to assess the quality of the documentation to support skilled Medicare and medical necessity Managed Medi-Cal /Medicaid and Managed Care/Insurance coverage. Documents pertinent narrative data to support clinical care and services.
• Collaborates with Social Services to ensure safe transitional/discharge plans are initiated upon admission and updated as indicated.
• Works with Business Office staff to ensure Medicare Part A services are appropriately billed and meet Medicare documentation guidelines.
Clinical Care Coordinator qualifications:
• Nursing degree from accredited college or graduation from approved RN or LVN program as well as current, unencumbered license to practice as an RN or LVN required.
• Previous Case Management or MDS experience and/or 5 years’ nursing experience preferred
• Strong clinical skills and previous experience in Long Term Care environment highly desirable
• Current valid CPR certification required
• Proficiency with Electronic Medical Records required; familiarity with Point Click Care preferred.
Compensation will be generous, and will be based upon professional experience.
Executive Search Solutions is a national healthcare recruitment firm with a focus on long-term care. Our clients include Skilled Nursing Facilities (SNF)/ Nursing Homes, Assisted Living and Independent Living centers, Continuing Care Retirement Communities (CCRC), Rehab, Hospice, Acute Care Hospitals, and Home Health Agencies.
Please call David Van Matre at 760-699-7671 for more information, fax resume to 877-685-8779, or email resume to dvanmatre@essusa.net to be considered for this position. We look forward to hearing from you.