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Profession: Case Management
Specialty: Case Management
Job Type: Travel
Minimum Guaranteed Hours: 40

Jobs Notes:
Day Shift/Mileage paid at federal rate
Job Summary:

Plans, organizes and directs home care services to meet the needs of patients in their homes. Manages a patient caseload in an effective and efficient manner. Provides patient care independently, but also collaborates with other core disciplines in accordance with the patient's plan or care to meet care goals. Functions as a resource to patients, family members, and other care team members.

Job Requirements:

Education and Work Experience:

Bachelor's Degree in Nursing (BSN): Preferred
Acute care facility or home care experience: Preferred
Licenses/Certifications:

Registered Nurse (RN) licensure in the state of practice: Required
Cardiopulmonary Resuscitation (CPR) or Basic Life Support (BLS OR HS-BLS OR RQIBLS) certification: Required
Valid Driver's License (DL) and must be at least 21 years of age or older: Required
Current automobile insurance and a reliable automobile: Required
Basic Life Support (BLS OR HS-BLS OR RQI BLS) certification: Required
Essential Functions:

Completes initial and ongoing comprehensive assessments of the patient's needs at appropriate time points as assigned. Completes the nursing assessment of assigned patients. Demonstrates ability to discuss and/or teach pertinent aspects of nursing care and patient rights and responsibilities. Identifies and reports problems, abnormal findings, or nursing diagnoses that need follow up.
Implements plan of care in accordance with identified needs. Participates with the patient in clarifying mutually agreed upon goals and incorporates these goals into the plan of care. Provides direct and/or indirect skilled, safe, quality care. Coordinates patient care with other disciplines and integrates input from disciplines. Performs ongoing nursing assessments and changes plans of care as needed.
Accurately completes and legibly documents all pertinent information in accordance with established policies and procedures by documenting patient care delivery, patient status, patient's response to treatment, and therapeutic interventions. Ensures that all documentation is completed and submitted in a timely manner. Updates nursing plans and medication profiles when changes occur.
Counsels and educates the patient and family in meeting healthcare/nursing and related needs. Provides learning opportunities for patient and caregiver, including written material as appropriate. Initiates appropriate preventative and rehabilitative nursing procedures.
Complies with all applicable legal requirements, standards, policies and procedures including, but not limited to the code of conduct, HIPAA, and documentation standards. Demonstrates professional conduct, service excellence and commitment to the mission and values of Adventist Health.On call duties will be assigned based on location and agency operational needs. If assigned by agency leadership, incumbent is required to perform on call duties.
Performs other job-related duties as assigned.
Organizational Requirements:

Adventist Health is committed to the safety and wellbeing of our associates and patients. Therefore, we require that all associates receive all required vaccinations as a condition of employment and annually thereafter, where applicable. Medical and religious exemptions may apply.

Adventist Health participates in E-Verify. Visit for more information about E-Verify. By choosing to apply, you acknowledge that you have accessed and read the E-Verify Participation and Right to Work notices and understand the contents therein.

Status: Full Time

Shift: M-F 7-3:30 with option for remote work

Exempt: No

Summary:

The Case Management Assistant will work collaboratively with the healthcare team, under the direction of the RN Case Managers, Social Workers, and Utilization Review Nurses to assist with the continuum of care, discharge planning, and authorization for hospital services.

Other information:

FACTORS RELATING TO THE JOB

A. Experience, Knowledge and Skill

1. Previous Experience Preferred:

Clerical experience or customer service experience is preferred.

2. Specialized or Technical Education Required:

Required: High school graduate or equivalent

Preferred: Medical Assistant training.

3. Manual or Physical Skill Required:

None

4. Physical Effort Required:

Strength: Sedentary

Push: occasionally

Pull: occasionally

Carry: occasionally

Lift: occasionally

Sit: frequently

Stand: frequently

Walk: frequently

Responsibilities:

Under the direction of the RN Case Manager and/or Social Worker:

1. Prepare and fax referral packets for post-acute care and any home medications with necessary documentation/information to appropriate company/facility.
2. Follow up on referrals by phone to ensure receipt of referral to intended company/facility and ensure all necessary information/documentation was provided.
3. Receive and respond to all fax/phone requests from facilities/companies and provide pertinent information to acquire approval/placement for patient's needs.
4. Contact insurance company for patients to acquire authorization and preferred placement/DME/transport information.
5. Verify patient personal information at bedside as needed for discharge needs.
6. Document all steps/conversations/information obtained, with patient/patient family members/facilities/agencies throughout the process of consult and placement/arrangement of needs in the medical record.

1. Communicate clinical review information via fax and/or phone to all third party utilization review companies
2. Maintain and document third-party payer authorizations, contacts, and transactions for individual patients
3. Facilitate the insurance denial appeals process by entering appropriate documentation into patient accounts and Auth/Cert page.
4. Facilitate peer-to-peer reviews and maintain log on Case Management drive.
5. Drop charts through EPIC CareLink to all appropriate payors when requested
6. Prepares and communicates census reports to payer representatives

1. Notify the RN Case Manager/Social Worker assigned to a patient of new orders for consultation.
2. Update all lists of post-acute providers quarterly and distribute to department staff.
3. Work in conjunction with Program Assistant to ensure medical record requests are provided timely to payer Utilization Review staff.

The Case Management Liaison's (CML) primary responsibilities are to perform selected services and functions related to patient care coordination, utilization review, discharge planning and data collection for the Case Management Program under the direction of the Case Manager. This includes communicating with third party review organizations, ordering discharge equipment and services, arranging patient transportation and community services.
Position Details

Status: Full Time, Non-Exempt

FTE/Hours per pay period: 1.0 FTE (80 hrs)

Shift: Day

Shift Length: 8

Pay Range: 22.70 - 31.80

Location: 9300 Valley Children's Pl, Madera, CA 93636 USA

About Us:
The Valley Children's Hospital Case Management department maintains a collaborative approach in coordinating and optimizing services for our most complex pediatric patients. This includes assessments, care plans, ensuring efficient resource utilization, and fostering communication among the care team. The Case Management process encompasses communication and facilitates care along a continuum through effective resource coordination. The goals of the Case Management team include the achievement of optimal health, access to care and appropriate utilization of resources. The case management team is responsible for utilization management, discharge planning and care coordination. This dynamic team aims to enhance the quality of care and support for our patients and families here at Valley Children's while promoting cost effectiveness and positive outcomes.

Valley Children's Healthcare - one of the largest pediatric healthcare networks in the nation - provides Central California's only high-quality, comprehensive care exclusively for children, from before birth to young adulthood. With more than 670 physicians and 3,500 staff, Valley Children's delivers high-quality, comprehensive care to more than 1.3 million children in our service area. Our network offers highly specialized medical and surgical services to care for children with conditions ranging from common to the highly complex at our 358-bed stand-alone children's hospital that includes 28 regional NICU beds. Our family-centered, pediatric services extend from a leading pediatric cancer and blood disorders center home on the West Coast, and a pediatric heart center known for its expertise and pioneering treatments, to a Regional Level IV neonatal intensive care unit (NICU), the highest level referral center between Los Angeles and the Bay Area. We participate in community initiatives, we support community efforts, we get involved where we can do the most good.

EXPERIENCE:

• Minimum one (1) year experience in a healthcare environment required

• High school diploma as accredited by the US Department of Education or GED required
• College degree - 2 year preferred

• Review scientific information to promote understanding around the appropriate disease state and available treatment options at Vanda
• Answering customer inquiries, both telephonically and by email, through clarifying desired information; researching, locating, and providing information
• Educating and providing customers with product and services information
• Identifying and escalating priority issues
• Document all call information according to standard operating procedures and regulatory requirements
• Fulfills requests to customers by clarifying desired information, completing transactions, and forwarding requests
• Exhibiting excellent decision making skills to make balanced decisions between communication with consumers and assuring communication is within regulatory guidelines
• Developing feedback mechanism to maintain clear communication with internal stakeholders and corporate account team regarding case management

• Four-year college degree required. Science, nursing, social work or other related discipline is preferred
• Outstanding interpersonal and customer-centric skills
• Excellent oral and written communication and listening skills
• Aptitude in problem analysis and problem solving
• Ability to multi-task and to operate in a fast paced environment
• Proficiency in MS Office; specifically Excel
• Excellent organizational skills

• Bachelors or better.

Job Type

Full-time

Description

Axiom Care is a fast-paced, rapidly growing substance abuse treatment and sober living housing provider with locations in the Phoenix metro area and Apache Junction. We primarily serve low-income and justice-involved individuals who are seeking to change their life for the better. We achieve this by offering multiple levels of care along with medical services, evidence-based professional counseling, case management, housing assistance, employment assistance, and more.

Job Summary

The Axiom Care housing program includes recovery education, employment services, and high needs case management in a sober living environment with specialized clinical programming at our collaborative outpatient site. This program serves the justice involved population who are looking to focus on recovery, build skills that enable successful reintegration into the community, reduce criminogenic thinking and behaviors and achieve independent living. The Case Managers focus on the various social determinants of health and structural obstacles that are necessary to address for the clients/residents to have the highest chance of successful recovery and community reintegration. The case manager is an integral member of the entire team. They will also assist in on-site activities and functions of the program, as assigned by the Facilities Manager and/or other admin staff.

Duties/Responsibilities

• Complete case management functions focused on a housing first and high needs case management model.

• Complete AHCCS application and employment specialty services and paperwork.

• Develop client-driven treatment plans and continually monitor and record treatment progress.

• Carry a caseload of clients through their residential stay.

• Collaborate with peer employees, other housing staff and management to ensure fidelity to program structure and guidelines.

• Assist clinical, housing, and support staff in coordinating care with external sources.

• Serve as a point of contact to ensure continuous collaboration and communication between the housing and treatment team.

• Works as part of highly communicative treatment team and supports staff in promoting treatment goals and values of the Axiom Care program.

• Complete documentation in the electronic medical record of: activities, interventions, client contact, client staffings and case management treatment planning.

• Ensure residents are attending and participating in all housing and clinical programming.

• Provide support to the client as they navigate their way through community supervision and treatment by providing education and community resources based on need of resident.

• Attend frequent site meetings with peers, clients (house meetings), and ongoing staff trainings.

• Liaison with partnering organizations and stakeholders including recovery group representatives (NA, AA, CBI, TERROS, VEYO, etc.).

• Identify and report ongoing maintenance and safety issues at facility.

• Transport clients to appointments as needed.

• Utilize coaching and motivational techniques to help clients achieve their treatment goals.

• Perform other duties as assigned by management.

Requirements

Supervisory Responsibilities

• None.

Required Skills/Abilities:

• Must be proficient in computer applications and electronic medical record systems.

• Proficient with Microsoft Office Suite or related software.

• Some assignments require an Arizona Fingerprint Clearance Card

• Current Arizona Driver License and a current satisfactory 39-month Motor Vehicle Record (MVR).

Education and Experience

• Minimum one year of case management knowledge and experience with the AHCCCS population, justice involved persons, chronically underhoused and the substance use treatment.

Required Competencies:

• SMI Clinical Evaluation - Identifying and connecting with clinic, Request for SMI evaluation.

• Identifying appropriate placement - Understanding appropriate placement upon discharge. Coordination of care with placement.

• Discharge planning - Culturally relevant. Provide current information. Teach life skills.

• Ability to problem solve/critical thinking, self-determined - Able to identify the need for further assistance. Understanding time management. Communication skills with team. Identify solutions for in the moment.

• Documentation - Knowledge of regulations. Prepare accurate, concise notes. Write comprehensive, clear psychosocial narrative. Record client progress in relation to treatment goals. Appropriate verbiage. Discharge summaries.

Physical Requirements:

• Prolonged periods of sitting at a desk and working on a computer.

• Must be able to lift up to 15 pounds at times.

• Coordinate the integration of case management and social services into the patient care, discharge, and home planning processes in collaboration with other departments, external organizations, agencies, and healthcare facilities.
• Provide leadership, supervision, and support to nursing and care staff in delivering clinical and care support services in a professional manner.
• Introduce self to the patient and family, explain the Clinical Case Manager's role, and provide contact information to facilitate communication.
• Enable patients and families to participate in decisions about their health and care needs.
• Act as a patient advocate; investigate and report adverse occurrences; provide staff education related to resource utilization, discharge planning, and the psychosocial aspects of healthcare delivery.
• Facilitate interdisciplinary patient care rounds or conferences to review treatment goals, optimize resource utilization, provide family education, and identify post-rehabilitation transition needs.
• Assist Social Services/Discharge Planner with care conferences.
• Negotiate with service providers, payers, and members of the care team to meet patients' care needs (including labs, x-ray, pharmacy, rehab, ambulance, equipment, etc.).
• Investigate and address concerns identified through the Rehab Post-Discharge Follow-up Program.
• Oversee the completion of certifications/re-certifications, Generic Notices of Non-Coverage, Detailed Notices of Non-Coverage, and related documentation for Medicare and Managed Care.
• Assist the MDS Nurse (Resident Assessment Coordinator) with completion of MDS assessments as needed.
• Lead the daily pathway meeting with the Rehabilitation Director to determine the most appropriate Assessment Reference Date (ARD) that ensures optimal reimbursement. Lead the weekly Utilization Review meeting.
• Communicate regularly with physicians during a patient's rehab stay to maintain appropriate cost control, case management, and desired patient outcomes.
• Complete comprehensive assessments of patient and family needs at admission. Complete the Discharge Disposition Assessment and Discharge Management Calendar with the Discharge Planner weekly.
• Conduct concurrent medical record reviews using indicators and criteria approved by medical staff, CMS, and other regulatory agencies.
• Provide education, information, and guidance to patients and families in a supportive and understanding environment.
• Maintain appropriate, legible documentation, records, and databases, and remain aware of the legal implications of all documentation.
• Evaluate and improve existing nursing practices and clinical guidelines in consultation with staff, patients, and management.
• Review utilization of services from admission through discharge to ensure appropriate resource use and timely achievement of clinical goals.
• Perform other duties as assigned.

• Graduate of an accredited School of Nursing; RN preferred.
• Valid California RN license.
• Minimum of one year of nursing experience in a long-term care environment preferred.
• Strong knowledge of the RAI process, CMS, and state and federal regulations pertinent to Skilled Nursing Facilities (SNFs).
• Ability to provide direction and coordination for a multi-faceted program and resolve facility-related issues.
• Excellent organizational, interpersonal, and communication skills (both verbal and written).
• Accurate, concise, and detail-oriented.
• Self-motivated, able to work independently, and manage multiple tasks in a deadline-driven environment.
• Proficient in computer skills, including email, internet usage, and word processing.

• Master's of Social Work, required
• 2 years of social work practice or student practicum, required
• Possession of a valid Driver's License with proof of a safe driving record for the past ten years and proof of auto insurance may be required. If required, must have an Oregon Driver's License within 30 days of moving to Oregon (if applicable).

• LCSW: Licensed Clinical Social Worker
• LMSW: Licensed Master's Social Worker

• Earn a competitive and progressive salary.
• Benefit from health plans that focus on health and wellness including medical, dental, vision and wellness beginning within 30 days of hire.
• Plan for your future with a retirement package that includes up to 6% employer contribution.
• Experience a healthy work-life balance with our generous earned time off (ETO).
• Continue to enhance your education through our tuition reimbursement and tuition repayment plans.

• Master's of Social Work, required
• 2 years of social work practice or student practicum, required
• Possession of a valid Driver's License with proof of a safe driving record for the past ten years and proof of auto insurance may be required. If required, must have an Oregon Driver's License within 30 days of moving to Oregon (if applicable).

• LCSW: Licensed Clinical Social Worker
• LMSW: Licensed Master's Social Worker

• Earn a competitive and progressive salary.
• Benefit from health plans that focus on health and wellness, including medical, dental, vision, and wellness beginning within 30 days of hire.
• Plan for your future with a retirement package that includes up to 6% employer contribution.
• Experience a healthy work-life balance with our generous earned time off (ETO).
• Continue to enhance your education through our tuition reimbursement and tuition repayment plans.