As the Manager of Case Management, you would assist the Director of Case Management in leading and managing facility-wide utilization management, outside medical service, and coordination of care and discharge planning. A Manager of Case Management would perform duties to conduct and manage the day to day operations of the case management functions communicating with staff to facilitate daily departmental functions.

Education and Experience

• A current RN certification may be required depending on the specific position
• Generally, a bachelor’s degree in nursing, health care management, or other related field is required
• At least a few years of case management experience is required for most positions
• Familiarity with all Medicaid managed care practices and policies
• Some prior experience in management of case management may be required depending on the position

Job Duties

• Appeal denied cases as well as assist physicians with appeals
• Assists physicians and other hospital personnel in understanding case management issues
• Works to provide in-house programs as needed for both staff and physicians
• Directs and coordinates data gathering and record keeping
• Assists the Director with creating, establishing, and implementing policies, practices, and procedures that are in accordance with all regulatory agencies
• Takes care of other tasks as assigned by the Director of Case Management

A Licensed Vocational Nurse (LVN), you will be looked to in order to promote the highest standards of care for your assigned patients, under the guidance of a Registered Nurse. The LVN performs a variety of patient care duties, and assists with patient and family education, while working cooperatively with all health care providers. The LVN utilizes observation techniques and assists medical staff to ensure the best care within established company policies and procedures.

Education and Experience Requirements

• Must have graduated from an accredited school of Vocational Nursing as a Licensed Vocational Nurse through the Boards of Vocational Nursing and Psychiatric Technicians
• Generally, at least a couple years of experience in a hospital setting is required for most positions
• Basic Life Support (BLS) certification through the American Heart Association, as well as Management of Assaultive Behavior (MAB), or equivalent is required
• Maintain CPR and/or First Aid Certification

Job Duties

• Provide back-up resident care and clinical services to Care Services Manager as needed
• Reviews assignments with Care Services Manager and Executive Director
• Maintains familiarity with patient records and documents within those records as needed, as well as keeps tabs on staff communication records
• Determines emergency medical measures to be taken in regards to patient care according to state regulations
• Provides services as indicated on patient treatment and service plans

The Coding Analyst is responsible for the oversight of all aspects of the organization’s coding dashboard, reporting system, and the data that is required to support these tools. The Coding Analyst also develops projects, utilizing planning, monitoring, and controlling processes. They are also responsible for the completion of a range of tasks which include, coordinating resources and stakeholders, setting deadlines, assigning responsibilities, and monitoring the progress of projects.

Education and Experience

• A Bachelor’s of Science of a Master’s degree is preferred for some positions, but may not be required
• The minimum of an Associate’s degree or equivalent experience is required
• A minimum of a few years’ coding experience is generally required
• Some utilization review or management experience is preferred
• Must have excellent written and oral communication skills
• Must be detail-oriented and organized, with solid problem solving skills

Job Duties

• Thorough understanding and ability to work with large amounts of data
• Designs and develops complex analyses of coding data in order to provide solutions
• Operationalize solutions by establishing an audit and reporting system on performance
• Closely understand the requirements of projects and ensure that all work proceeds on-schedule
• Efficiently manage and resolve problems, if things do go off plan. Bring them back on plan, or create a new plan that fulfills the needs of the stakeholders
• Makes day to day decisions on analytic needs in order to support the team
• Consistently monitor and report on the progress of projects to their respective stakeholders

A Clinical Supervisor is primarily responsible for overseeing behavioral therapists, and managing caseloads of clients receiving Applied Behavior Analysis (ABA) services. They are also responsible for the management of their caseload including conducting initial assessments, writing reports, developing plans for behavior intervention, and monitoring on-going processes.

Education and Experience

• Generally, a Master’s Degree in Psychology or a related field of study from an accredited institution is the minimum education required, in addition to CPI, CPR, and First Aid certifications
• A minimum of a few years of experience in the design and implementation of behavioral intervention services is required
• At least 3 years working with individuals diagnosed with developmental disabilities is required for most positions
• A few years of supervisory experience is generally required

Job Duties

• Works to assist the program manager or clinical director with functional assessments
• Develops intervention strategies focused on positive practices in order to decrease interfering behavior and increase functional skills
• Provides parental consultations as needed
• Works to facilitate clinical meetings to go over progress on a monthly basis
• Oversees behavior therapists and provides them with periodic evaluations
• Assists with interviews, observations, and preparations of initial behavior assessments

A Clinical Compliance Coordinator is a Registered Nurse who assists the Director of Clinical Services in the supervision of home health services to patients in their residences, in accordance with physician orders, and strives to provide only the highest quality care. The Clinical Compliance Coordinator is to be available at all times during operating hours, and participates in all activities that are relevant to helping develop a plan of care for all patients.

Job Responsibilities

• Strict adherence to established policies and procedures
• Helps to develop standards which ensure the safest and most effective service to the patient
• Supervise, guide, and develop nursing skills and performances
• Responsible for the training and orientation of new patient care staff
• Helps to plan and consult on the needs of the staff
• Serve as a role model and resource for all staff and colleagues by setting an example of high standards in fields like dress, conduct, and job performance.
• Responsible for reporting accidents, incidents, or unusual occurrences to the Director of Clinical Services

Qualifications

• A diploma in Nursing or other similarly qualified clinical education is a minimum
• Bachelor’s degree preferred
• Minimum of a couple years of home health experience generally preferred
• Strong knowledge of government and private insurers, including Medicare and Medicaid
• Experience in supervising and managing staff
• Strong organizational skills, as well as the ability to multi-task
• Solid computer and internet skills

Licensed Practical Nurses (LPN) work many different roles in the healthcare field, some of which are providing routine care, observing patients’ health, assisting doctors and registered nurses (RN), and acting as an intermediary between patients and their families. LPN’s can also work privately for families or work with businesses to provide basic care and health consultations to employees. As a LPN, opportunities also exist to work in government facilities, both state and federal, working as a consultant regarding health-related issues and programs.

Job Duties

• Assists in the development of individualized care plans for patients
• Works with patients to achieve their rehabilitation goals, in line with their care plan
• Takes note of the general physical and mental condition of patients, as well as signs and symptoms
• Distributes assignments to CNA’s
• Admits and discharges patients
• Assists with diagnostic procedures as needed
• Perform basic therapeutic procedures and treatments
• Supervises team members to ensure that all duties are provided efficiently and with care

Education and Qualifications

• Completion of a Practical Nursing program required
• At the very least, a High School diploma or equivalent, and a few months of experience are required
• Be able to supervise a limited number of employees
• Strong written and oral communication skills
• A strong knowledge of basic math such as: addition, subtraction, multiplication, and division of various units of measure

A Case Manager Nurse uses the nursing process to plan, implement, and evaluate the quality of patient care, and the use of resources. A primary focus is to monitor the quality of care in order to assure that there are appropriate levels of risk management. As a Complex Case Manager Nurse, you would also act as an advocate for patients and their families, and work with medical facilities such as hospitals and assisted living facilities. A Complex Case Manager Nurse facilitates the care of patients with complex issues such as mental health or substance abuse.

Job Duties

• Acts as a primary source of care for patients with complex health needs, with a wide range of engagement
• Conduct clinical assessments over the phone to address the health and wellness needs of patients using a set of clinical interviewing skills
• Develop care plans based on patients specific needs by using the clinical information system to establish treatment goals
• Communicates with the patients other care providers in more complex situations requiring case management intervention.
• Serves as a subject matter expert to clinicians to provide education, consultation, and training when needed
• Incorporates lifestyle improvement and prevention opportunities into member interactions

Education and Qualifications

• Ability to work a flexible schedule
• Current RN license is required
• Generally, a Case Management Certification (CCM) is preferred
• A Bachelor’s or Master’s in Nursing is also a preferred qualification
• At least some experience working with the healthcare needs of a variety of people

A Clinical Appeals Coordinator’s primary role is to act as a liaison for all statewide appeals, fair hearings, review organizations, and other external type appeals. The Clinical Appeals Coordinator is also responsible for ensuring that all appeal letters that are generated comply with all requirements, whether they be State or NCQA requirements

Job Duties

• Reviews clinical information for all appeals by using criteria that is nationally recognized, in order to determine the actual necessity of the services that are requested
• Prepares reviews for cases that do not meet the required criteria
• Coordinate and deliver verbal and written information regarding patient and provider appeals, and ensure all letters are in line with all required standards
• Maintains files and logs related to all appeals
• Coordinates hearings with various internal departments and agencies

Education and Qualifications

• For some positions, a RN certification is required, or LPN with more experience may be substituted in some situations
• Generally, at least a few years of clinical nursing or case management experience is required, with more being required for LPN applicants
• Managed care experience or utilization review experience preferred for some positions