Case Manager / Utilization Review RN

Busy 307-bed skilled nursing facility located in Alexandria, VA seeks qualified candidates for Case Manager and Utilization Review Coordinator.The CM / UR Coordinator will oversee all case managed residents and communicate pertinent information to insurance companies, resident / responsible parties, and all disciplines as needed to ensure appropriate utilization of available resources.  Reporting directly to the Director of Marketing & Census Development, the incumbent's duties will include:

 

Records details of admission such as diagnosis, discharge date and place, rehab, and clinically complex information; ensures that skilled care residents meet Medicare criteria throughout their stay; ensures that Medicare Certification form is completed within the required time frame; facilitates the weekly UR team meeting; provides insurance companies and case managers with initial therapy evaluations upon admission; provides updates to insurance company case managers to include diagnosis, treatment, process in therapy disciplines, rehab discharge dates, and discharge plan; prepares weekly change-in-status list to keep ID team apprised of private insurance and Medicare denials as well as discharges or changes in status; prepares denial letters for residents who will be denied Medicare coverage; issues resident payment source status changes for all Medicare and private insurance residents to appropriate facility departments; handles Medicare appeals when notified by VHQC; assists facility Social Services Department with discharge planning efforts and activities.

 

RN highly desired but experienced LPN will be considered.  Must have 2 years clinical experience in long term care, knowledge of PPS / Rugs system, and must be proficient in Microsoft Word and Excel.  Previous case management and / or utilization review experience a BIG plus. 

 

Woodbine Rehabilitation & Healthcare Center is located on King Street in Alexandria just minutes from I-395 and Old Town.  Fax resume to Peggy Ward, HR Manager at (703) 797-9548 or apply on-line at www.cambridge-care.com/careers.htm.