Case Manager

Job Details: Salary Range: Undisclosed, JOB DESCRIPTION SUMMARY Responsible for direct and indirect support services to patients to help access services, engage and maintain medical care, and achieve positive outcomes. Case Managers can also promote the empowerment of patients, and assist with care management activities. ESSENTIAL JOB FUNCTIONS

1. Performs duties consistent with the Vocational Nursing Practice Act.
2. Coordinates home care services for home health patients, assists with the establishment of the plan of care in coordination with the physician, insurance, Clinical Managers and ensures a seamless transition to home health care.
3. Verifies insurance coverage and obtains initial authorizations for services and seeks reauthorization for ongoing and additional services.
4. Works with Clinical Managers and clinicians to gather, collate, and report patient care summary information to Primary Care Physicians.
5. Maintains comprehensive working knowledge of contractual relationships and ensures that patients are admitted and services are delivered in accordance with contract provisions.
6. Establishes and maintains positive working relationships with current and potential patients and caregivers.
7. Promptly responds to patient’s requests and concerns.
8. Assists in building community, customer, payer and patient perceptions of MIRACLE HOME HEALTH CARE INC. as a high quality provider of services.
9. Maintains comprehensive working knowledge in the field of home health and shares information with appropriate agency personnel.
10. Maintains comprehensive working knowledge of community resources and assists customers in accessing community resources should services not be provided by MIRACLE HOME HEALTHCARE INC.
11. Participate in monthly Miracle Home Health Inc. In-Services
12. Performs daily the QA of (30) thirty patient specific nursing skilled visits notes (eligibility days excluded) 13.Responsible for maintaining the accurate health insurance of all patients by checking and updating patient medical eligibility via Med-Cal / LA CARE portal and Medicare. The above statements are intended to be a representative summary of the major duties and responsibilities performed by incumbents of this job. The incumbents may be requested to perform job-related tasks other than those stated in this description. ESSENTIAL DAILY RESPONSIBILITIES
13. PEN

• WORK ON "PEN" EVERY MORNING. GO TO SEARCH AND TYPE "PEN"

1. CALL YOUR PATIENT INTRODUCE YOURSELF

• CONFIRM ADDRESS, COVID SCREENING, ASK IF PATIENT IF HE/SHE GOT THE FLU SHOT AND COVID VACCINE.

1. CONFIRM PCP. IF INITIAL AUTHORIZATION IS STILL PENDING, CALL HEALTH PLAN TO FOLLOW UP TO CONFIRM IF THE AUTHORIZATION WAS RECEIVED AND/OR IF STILL PENDING. DO NOT FORGET TO ASK FOR THE NAME OF THE PERSON YOU SPOKE TO AND ASK THE REFERENCE NUMBER OR PENDING AUTH NUMBER
2. CREATE COMMUNICATIONS

• AS MUCH AS POSSIBLE ALWAYS ASK WHO YOU SPOKE WITH, INCLUDE REAL TIME TO YOUR NOTES. SIGN AND COMPLETE.

1. PLOT DISCIPLINES

• SCHEDULE ACTIVITY SCHEDULE MANAGER
• SCHEDULE EMPLOYEE

1. FOLLOW UP ON PT/OT/ST/MSW EVAL IF EVALUATION IS STILL NOT COMPLETED WITHIN 24-48 HOURS FROM THE DATE PLOTTED
2. EDIT PHYSICIANS ADDRESS AND/OR FAX NUMBER

• VIEW
• LIST – PHYSICIANS

1. SEARCH FOR EMPLOYEE CONTACTS

• VIEW
• LIST – USERS

1. CALL YOUR PATIENTS ONCE A WEEK FOR FOLLOW

• UP CALLS TO ESTABLISH A RELATIONSHIP WITH YOUR PATIENT
• ASK HOW ARE YOU DOING? HOW ARE THE NURSE/PT/OT/ST/HHA/MSW VISITS? IS THERE ANYTHING YOU NEED? DO YOU STILL HAVE SUPPLIES? ARE YOU TAKING THEIR MEDICATIONS? WHEN IS YOUR NEXT PCP APPT? DO YOU HAVE ANY QUESTIONS?

1. ASSIGN NURSES BASED ON THE AREA THEY COVER

• USE THE MAP TO GUIDE YOU

1. FAX ORDERS IF ORDERS ARE STILL NOT "RETURNED W/PHYSICIAN SIGNATURE" CREATE FAX COVERS, ATTACH ALL UNSIGNED ORDERS THEN CLICK SEND. ATTACH THE ONCE IT HAS BEEN SUCCESSFULLY SENT. CALL PCP OFFICE TO CONFIRM IF THEY RECEIVED THE FAX YOU JUST SENT TO BE SENT TO PHYSICIAN

• FAX ORDERS a. SENT TO PHYSICIAN (ELECTRONICALLY)
• FAX ORDERS b. SUBMITTED (PENDING QA REVIEW)
• DO NOT FAX YET c. RETURNED W/PHYSICIAN SIGNATURE
• DO NOT NEED TO FAX IT WAS SIGNED AND FAXED BY THE PHYSICIAN ALREADY

1. YOU MUST SUBMIT YOUR N/A BY THE END OF THE DAY OR AS SOON AS YOU RECEIVE THE N/A LIST VIA TEXT TO HAZEL AND/OR IN YOUR ASSIGNED GROUP THREAD BASE ON YOUR ASSIGNED LETTER(S)
2. MANDATORY

• CALL 2 PATIENTS EVERY THURSDAY FOR "CUSTOMER SERVICE a PHONE SURVEY" CREATE A COMMUNICATION NOTE COMMUNICATION TEXT "SELECT TEMPLATE", SELECT "CUSTOMER SERVICE PHONE SURVEY
• MHHCI" ANSWER QUESTIONS: YES, NO OR N/A. COMPLETE YOUR COMMUNICATION NOTE.

1. EVERY 1ST AND 15TH OF THE MONTH IS ELIGIBILITY DAY
2. CONFIRM EVV IS BEING DONE FOR ALL MEDICAID PATIENT VISITS
3. MEDICARE/MEDICARE HMO PATIENT ARE REQUIRED TO RECEIVE A NOMNC AT LEAST 2 DAYS BEFORE DISCHARGING ESSENTIAL WEEKLY TASKS MONDAY: Catheter Rounds / No Activity (NA) Report TUESDAY: (5) Days & Above / No Activity (NA) Report WEDNESDAY: Physician Orders / No Activity (NA) Report THURSDAY: (2) Courtesy Calls / Physician Orders / No Activity (NA) Report FRIDAY: (10) Days & Above / Physician Orders / No Activity (NA) Report Qualifications: POSITION QUALIFICATIONS
4. Current licensure to practice professional nursing in California. Licensed Vocational Nursing minimum.
5. Previous experience in care coordination, preferably in home health care is strongly recommended.
6. Familiarity with medical terminology
7. Excellent reading, writing and communication skills
8. Ability to learn different technology programs quickly
9. Great organizational skills and the ability to manage large caseloads
10. Proficiency in Microsoft Word, Excel, Google docs and PowerPoint required
11. Complies with acceptable professional standards and practice.
12. Experience and knowledge regarding the physical, mental and social needs of the patients highly desirable
13. Demonstrates autonomy, assertiveness, flexibility, and cooperation in performing job responsibilities.
14. Conduct oneself with the utmost integrity, honesty and transparency towards patients, caregivers and colleagues PHYSICAL DEMANDS The physical demands are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is regularly required to have prolonged or considerable time sitting. The employee must occasionally be able to lift/move 50 pounds minimum. Able to lift supplies and equipment. Considerable reaching, stooping, bending, kneeling, or crouching. Visual acuity and hearing to perform required skills. JOB DESCRIPTION DISCLAIMER This position requires compliance with Miracle Home Health Care, Inc. written standards, including its Standards of Conduct and policies and procedures (“Written Standards”). Such compliance will be an element considered as part of the Care Coordinator performance evaluation. I have reviewed and understand the job functions required of me for the position in employment with Miracle Home Health Care, Inc. I understand that Miracle Home Health Care, Inc. reserves the right to modify job duties or job descriptions at any time.