SNF Case Manager

Description

• Put Patients First
• Empower Entrepreneurial Provider and Care Teams
• Operate with Integrity & Excellence
• Be Innovative
• Work As One Team

What You'll Do

• Manage transitions of care for members in SNF, SA, ARU, and LTAC settings using established clinical guidelines and medical necessity criteria.
• Conduct initial and concurrent reviews of medical records and coordinate care plans to support appropriate levels of care and reduce hospital readmissions.
• Collaborate with hospitalists, discharge planners, providers, facilities, and health plans to ensure effective discharge planning and care coordination.
• Communicate determinations, maintain compliance with regulatory and delegation requirements, and provide exceptional customer service to internal and external stakeholders.
• Attend case management meetings, provide onsite facility support as needed, and maintain strong relationships with providers, facilities, and medical directors.

Qualifications

• Active and unrestricted Texas Registered Nurse (RN) or Licensed Vocational Nurse (LVN) license
• At least 2 years of clinical nursing experience
• Proficiency with Microsoft Office Suite, including Word, Excel, and Outlook
• Strong analytical and critical thinking skills
• Ability to prioritize multiple responsibilities in a fast-paced environment
• Excellent communication, customer service, and relationship-building skills
• Strong organizational skills and attention to detail
• Ability to work independently and collaboratively within a team environment

• Previous case management experience
• Skilled Nursing Facility (SNF) experience
• Experience working with ARU, LTAC, or Sub-Acute populations
• Experience using EZCAP
• Managed care, IPA, or health plan experience
• Experience educating or training staff and cross-functional teams

• Demonstrate strong clinical judgment and critical reasoning skills
• Are self-motivated, proactive, and eager to learn
• Can manage competing priorities while meeting deadlines
• Maintain professionalism in all interactions
• Have strong problem-solving and organizational skills
• Understand both the details and the broader impact of patient care decisions
• Enjoy working collaboratively while also thriving independently
• Have experience in SNF and/or case management environments

Environmental Job Requirements and Working Conditions

• Ability to travel to facilities for onsite case management activities as needed
• Ability to work in a fast-paced healthcare environment with changing priorities
• Frequent use of computers and electronic medical record systems
• May require participation in onsite and offsite meetings with providers, facilities, and health plan partners