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SNF Care Manager

SNF Care Manager

Job Title: SNF Care Manager
Job Category: Nursing (RN)
Division: Torrance Health IPA
Position Type: Full time
Shift Length: TBD
Location: Torrance, CA

Resumes go to: Barbara.Latam@tmmc.com​

The purpose of the Skilled Nursing Facility (SNF) Care Manager is to support the physician and interdisciplinary team in the provision of member care, with the underlying objective of enhancing the quality of clinical outcomes while managing the effective utilization of hospital resources.

The SNF Care Manager is responsible for assessing the needs of THIPA/ACO members in skilled nursing facilities.

The SNF Care Manager functions in a direct care manager role. The role integrates and coordinates utilization management and discharge planning throughout the continuum of acute care, SNF, ambulatory care management and home health, including the care management of selected members being treated in outside acute care hospitals.

Primary Duties and Responsibilities:

  • Conducts a comprehensive assessment of member’s health status, activities of daily living, psychosocial, cultural and linguistic needs, available benefits and resources, caregiver resources, life planning activities and community resources via phone or in-person at the SNF facility
  • Creates an individualized care plan that meets member needs; includes prioritized goals, development of schedules for follow-up, communication with member of self-management plan
  • Documents member’s assessments, care plans, goals, and interventions in electronic medical management system according to NCQA standards
  • Evaluates member’s progress against care plans, goals, interventions, and modifications as needed
  • Manages all aspects of member care related to skilled nursing facility admissions
  • Establishes a plan of care for member while in facility and to address transition to lower level of care
  • Communicates and coordinates services with member and member’s care team, such as Primary Care Physician (PCP), specialists, medical providers, and ancillary providers as necessary to meet member’s medical and psychosocial needs
  • Facilitates member access to behavioral health, social services and community based services as needed
  • Actively participates in Interdisciplinary Care Team Meetings
  • Manages all aspects of discharge planning for assigned members
  • Proactively identifies and resolves delays and obstacles to discharge
  • Educates and provides member/family information about community resources
  • Manages referrals for post discharge care needs
  • Arranges transportation for member as needed
  • Coordinates transition to assigned Ambulatory Care Manager as needed
  • Issues the require Notice of Non Coverage (NOMNC) per regulatory guidelines
  • Issues Detailed Explanation of Non-Coverage per regulatory guidelines based on member appeal
  • Promotes post discharge continuity
  • Calls members, caregivers/family member day after discharge to ensure discharge plan was completely executed, including DME, Home Health, supplies, etc.
  • Ensures that privacy and confidentiality are maintained in accordance with state and federal requirements and all HIPAA regulations
  • Remains current with relevant healthcare requirements and the relevant professional literature

Requirements:

  • Register Nurse or Licensed Vocational Nurse with unrestricted CA license
  • Two years acute or subacute hospital experience or two years’ experience in home health, utilization or case management
  • Knowledge of Milliman Care Guidelines
  • CCM certification preferred
  • Thorough knowledge in case management
  • Ability to establish and maintain rapport with members, families, and caregivers
  • Ability to establish and maintain professional relationships and communications with the care team, such as physicians, social workers, Inpatient Case Managers, and ancillary providers etc.
  • Excellent verbal and written communication skills
  • Knowledge of health plans and experience with navigating health plan and community resources
  • Good command of the English language
  • Computer Literate
  • Ability to handle multiple tasks simultaneously and set appropriate priorities independently
  • Ability to maintain confidentiality of all member information.

Qualified candidates should submit their resume to Barbara.Latam@tmmc.com for consideration.