Case Manager/ HMO Liaison for Skilled Nursing Facility

About Us

Centrally located in Torrance, California, Sunnyside Nursing and Post-Acute Care provides sub-acute nursing care, rehabilitation services, skilled nursing, and long-term care. Our compassionate staff offers individualized care plans for each resident to ensure personalized care is provided to all our patients with a goal to return home.

Our team of qualified professionals provides compassionate care by:

• Maintaining high medical integrity
• Fostering a team spirit among staff
• Creating friendly, beautiful surroundings for our residents and their visitors

We understand the importance of creating a comfortable and nurturing atmosphere, whether residents stay for short-term treatment or long-term care.

Case Manager/ HMO Liaison is responsible for the oversight and management of skilled residents which includes being liaison between patient & insurance company, sending necessary paperwork to insurance company within timely manner, discharge planning, managing up to discharge and issuing denial letters. Coordinates with the assigned physician to manage skilled nursing residents and directs families, residents, physicians, nurse practitioners and SNF staff to the appropriate level of care. Complies with other duties as described below. Must be able to work collaboratively with the Multidisciplinary team.

Job Description

• Act as the liaison between the resident, clinical staff and insurance
• Obtain and receives HMO authorization for services including part "B" authorization
• Assist in ordering equipment, updating HMO tracking census, logs, etc.
• Update tracking for nursing and therapists
• Greet new residents ensuing a positive admission experience
• Evaluate and communicate resident status, changes in functions and care plans to Health Plans and IDT
• Arrange transportation and schedule specialty appointments during SNF stay
• Coordinate discharge planning
• Manage NOMNCs
• Meet with interdisciplinary team to coordinate services ensuring resident’s total regimen of care is maintained
• Coordinate and communicate with business office and medical records to ensure accurate census and payment of Managed care and Medicare residents
• Attend scheduled meetings and care rounds

Requirements

• Current LVN license or
• Bachelor's degree in social work, psychology or related human services field with at least 2 years work in case management
• Prior case management experience at skilled nursing, acute care, or health plans
• Ability to understand and interpret medical terminology, diagnoses, and records
• Experience working with HMO authorizations and contracts
• Excellent Microsoft skills - Excel/ Google Suite
• Strong written & verbal communication skills
• Experience with PCC

Ideal Candidate:

• Detail oriented individual who is passionate and dedicated to their work. Very familiar and comfortable with case management and HMO authorization process.

Shift:

Full-Time

Monday - Friday

8:00 am - 5:00 pm

Benefits

Why Work for Sunnyside Nursing & Post-Acute Care

• Top of the market wages: $32.00 - $42.00 per hour
• Paid orientation and training
• Opportunities for growth
• Loving and caring work environment

We take great pride in meeting or exceeding CDC and CMS standards. On-site experts provide teaching, coaching, and support on infection prevention practices. In addition, we maintain an abundant supply of PPE, including N95/KN95 masks, for all who provide care and services to our patients and residents. Our multiple testing capabilities, including Point-of-Care (POC) testing, are available at every location and comply with CMS and local guidance

If hired, we require that all employees be vaccinated, unless a medical or religious accommodation is needed.

EQUAL OPPORTUNITY EMPLOYER

We are an equal opportunity employer. We celebrate diversity & pride ourselves on creating an inclusive environment for all employees and residents.