Job Summary:

• Building a relationship with PDN clients and their caregivers
• Completing initial evaluations and re-evaluations
• Participating in admissions and start of care for new agency patients
• Overseeing client's plan of care and providing feedback on changes needed to the plan of care
• Requesting service authorizations from MCOs
• Supporting the Director of Nursing / PDN team
• Reviewing referral information for compliance with Medicare regulations
• Follow up with RCD process for additional information requested
• Oversee patient scheduling, review orders and take verbal orders
• Participate in team meetings and clinical meetings
• Review charts for medical necessity for recertifications and discharges
• Taking over for the Director of Nursing when she is performing other duties.

Skills on Resume:

• Clinical Assessment (Hard Skills)
• Regulatory Compliance (Hard Skills)
• Care Coordination (Hard Skills)
• Leadership Abilities (Soft Skills)
• Problem Solving (Soft Skills)
• Record Management (Hard Skills)
• Team Collaboration (Soft Skills)
• Communication Skills (Soft Skills)

Job Summary:

• Provides client case management by conducting assessments with clients and their families to develop full care plans.
• Performs patient assessments based on agency standards of practice 
• Ensure effective and appropriate home health care services.
• Directs, plans and initiates appropriate action independently and responsively in home health care situations.
• Supervises LVNs, home health aides and personal care aides
• Provide effective and quality home health care services.
• Completes assigned tasks within established guidelines and time frames.
• Documents OASIS assessments in the system within the given time frames.
• Coordinate community care and services as deemed appropriate

Skills on Resume:

• Case Management (Hard Skills)
• Patient Assessment (Hard Skills)
• Service Coordination (Hard Skills)
• Independent Action (Soft Skills)
• Staff Supervision (Soft Skills)
• Quality Assurance (Hard Skills)
• Time Management (Soft Skills)
• Documentation Skills (Hard Skills)

Job Summary:

• Check hospital censuses daily from CareAnalytix, Availity, Wellmed, Aetna, Experian, and media sites
• Address all faxes received for admissions and discharges daily. 
• Notify providers and the MSO team daily of all admissions (IP and obs), ED visits, and SNF transfers via email.
• Alert Case Managers to newly identified issues/needs of their patients who in turn communicate with the appropriate provider.
• Notify WH/LKld case managers via a patient’s TE of admissions (IP/obs), ED visits, and SNF transfers
• Keep a monthly excel spreadsheet of all hospital admissions by the patient (IP, obs, ed, and SNF) including individual provider sheets with the same information (updated daily).
• Keep a yearly excel spreadsheet updated monthly of each Insurer’s total admissions (IP, obs, ed, and SNF).
• Make note of patients’ progress during admissions and make note of scheduled f/u appointments.
• Send a mid-month report of each insurer's IP, Obs, ED, and SNF admissions.
• Review current and previous month spreadsheets to ensure f/u has taken place. 

Skills on Resume:

• Data Analysis (Hard Skills)
• Record Management (Hard Skills)
• Communication Skills (Soft Skills)
• Alert System Management (Hard Skills)
• Spreadsheet Proficiency (Hard Skills)
• Report Generation (Hard Skills)
• Follow-Up Coordination (Soft Skills)
• Information Synthesis (Hard Skills)

Job Summary:

• Adhere to Special Needs Plan Model of Care program goals and objectives
• Meet the members individualized healthcare needs through adherence to program policies and procedures
• Perform telephonic case management and care coordination activities, communicating with the multidisciplinary team
• Review each case individually and evaluates for referral to Social Services, Behavioral Health, Disease Management, community resources and other resource needs
• Collect pertinent clinical information, documenting findings using the Acuity case management system
• Evaluate and complete the Health Risk Assessment which includes physical, psychological, emotional and environmental assessments
• Provide appropriate, timely interventions to ensure provision of optimal care
• Develop an individualized care plan for each member along with the member and/or family and through collaboration with the Interdisciplinary Care Team (ICT)
• Provide ongoing evaluation and management of the members progress, effectiveness of the care plan, as well as, the efficacy and appropriateness of services provided

Skills on Resume:

• Policy Adherence (Hard Skills)
• Case Management (Hard Skills)
• Telephonic Coordination (Hard Skills)
• Needs Evaluation (Hard Skills)
• Clinical Documentation (Hard Skills)
• Risk Assessment (Hard Skills)
• Care Planning (Hard Skills)
• Progress Monitoring (Hard Skills)

Job Summary:

• Maintain contact with the injured workers, employers, medical providers and attorneys.
• Develop and update medical management and return-to-work strategies.
• Provide recommendations for independent medical exams or file reviews.
• Provide assessments of medical reports in conjunction with applicable guidelines and experience.
• Manage medical treatment including prescriptions.
• Perform utilization reviews on a timely basis.
• Ensure injured worker compliance with recommended treatment and assist with expediting appointment scheduling.
• Adhere to State Laws and Regulations, company Best Practices and specific account instructions
• Access the Workers’ Compensation Board website regularly for individual claim information and Medical Treatment Guidelines, references and notices.
• Maintain current knowledge of Workers’ Compensation Board updates on medical management. 

Skills on Resume:

• Stakeholder Communication (Soft Skills)
• Strategy Development (Hard Skills)
• Medical Evaluation (Hard Skills)
• Treatment Management (Hard Skills)
• Utilization Review (Hard Skills)
• Compliance Monitoring (Hard Skills)
• Regulatory Adherence (Hard Skills)
• Information Access (Hard Skills)

Job Summary:

• Work with multiple vendors and negotiate costs.
• Provide medical training to the claims staff.
• Help other nurse case managers 
• Document all activities in the claim system and record corresponding billing.
• Consult and collaborate with the Medical Director of Case Management regarding member cases related to appropriateness of care
• Guidelines evidenced based clinical, medications and other treatment plans, individualized care plans and resource needs required to meet/manage the members level of care
• Comply with performance and reporting standards as defined by Vantage Health Plan and CMS
• Participate on the QI Committee, Case Management Committee, and SNP Quality Committee
• Remind other nurse case managers or appointment desk if patients have not had f/u or have canceled appts and not been rescheduled.
• Keep in contact with other team members regarding CM patients’ Plans of Care/progress in reaching goals.

Skills on Resume:

• Vendor Negotiation (Hard Skills)
• Medical Training (Hard Skills)
• Peer Support (Soft Skills)
• Documentation Skills (Hard Skills)
• Collaborative Consultation (Soft Skills)
• Compliance Adherence (Hard Skills)
• Committee Participation (Soft Skills)
• Team Coordination (Soft Skills)