Therapy Case Manager

Job Type: Full-Time

Position Description

Responsible for ensuring the continuity of care utilizing the appropriate resources within the parameters of established

contracts and resident health plan benefits. Facilitates continuum of patient care utilizing advanced nursing knowledge,

experience and skills to ensure appropriate utilization of resources and patient quality outcomes. Performs care management

functions on-site or telephonically for assigned region.

Principal Responsibilities

• Responsible for communicating efficiently with the facility status while prior authorization is being obtained.
• Attains authorization for Part B and Medicaid therapy services to ensure facility reimbursement.
• Alert appropriate management team members regarding late or missing documents required for data entry/prior

authorization approval.

• Provide excellent customer service to patients, families, and referral sources.
• Patient’s Advocate- Coordinate and provide care that is safe, timely, effective, efficient, equitable, and client-centered.
• Direct line of communication to external insurance Case Managers.
• Maintain a tracking system to ensure all authorization requests are completely timely.
• Safeguard all authorization documentation for future access.
• Request and obtain continued authorization during the members stay.
• Submit initial therapy evaluations to external insurance providers within 24 hours of request.
• Follow up on all pending authorizations within 48 hours.
• Provide facilities with a detailed explanation of approved and denied therapy requests.
• Able to analyze various types of data reports and perform SWOT analysis- (Strengths, Weaknesses, Opportunities,

Threats) and suggest improvements or changes in strategy to supervisor.

• Adhere to professional standards as outlined by protocols, rules and regulations.
• Performs any miscellaneous work assignments as may be required.
• Collaborates across the organization and with external partners, utilizing a systematic, comprehensive, data-drive

approach to achieve clinical quality goals and improve overall resident care standards and health outcomes.

• Contributes to the success of the company's organizational strategic planning process; collaborates in the evaluation

of business lines and growth opportunities

• Leads best practice and quality improvement initiatives in skilled nursing.
• Develops and utilizes a standardized process to evaluate and evolve practice to decrease variability and improve the

care and safety of patients.

• Ensures compliance with governmental accrediting and licensing organizations including reimbursement and

certification requirements of third-party payers.

• Utilizes and manages the distribution and utilization of survey information to address areas of importance as defined

by our community and service partners.

• Ensure regulatory compliance to all federal, state and local regulations and laws relating to nursing home

administration; guide facilities to operate within established company policies and practices

• Cultivates a work environment that allows for creative thinking, problem solving and empowerment in the

development of a facility management team.

• Helps the Administrator prepare staff for inspection surveys, instructing staff on matters of conduct and disclosure,

being interviewed by inspectors, immediate corrections of problems noted by surveyors, etc. Reviews and reinforces

important standards previously cited.

Job Description Manual

• Promotes a safe environment within the facility, which includes fire and accident prevention, maintenance of sanitary

conditions and assurance that all nursing personnel understand their roles in the event of a disaster or other disruption

of services.

• Other duties, responsibilities and activities may change or assigned at any time with or without notice.

Business Development Responsibilities

• Supports the marketing strategy for the company that reflects service opportunities, competition, potential market

area changes, and which maximizes census, clinical services, and ancillary revenues.

• Supports the leadership and monitoring of key staff to play an active role in carrying out the marketing plan. Take

initiative in evaluation, development and implementation of new business opportunities that meets the needs of the

community and benefits the facility/Company.

• Support facility teams in their development of positive relationships on behalf of the Company with government

regulators, residents, families, area health care, physicians, and the community at large. Acts as a resource of

information to the community related to health care issues.

Financial Management

• Collaborates with management in preparing the annual departmental budgets using corporate guidelines to ensure

adequate resources for staffing, supplies and capital items needed.

• Utilizes payroll reports in managing and monitoring the staffing of the department.
• Ensures adequacy of supplies and equipment for current need and projects future cost impact.
• Prepares suggested 911 needs for department during the budgeting process.
• Oversees the operation of the department in accordance with the approved budget through effective use of corporate

and facility financial reports.

• Using the monthly P&L and other available reports, monitors PPDs, trends outcomes, documents variances and

communicates corrective action plans to management.

• Assists in planning, coordinating, and conducting continuing education programs and special in-service training

sessions relevant to the needs of department personnel.

• Staffs the department with capable people.
• Ensures that employees are adequately oriented and trained to perform their duties.
• Reviews employee performance annually and makes recommendations for pay increases, promotions or performance

improvement plans as deemed appropriate.

• Establishes and maintains effective two-way communication to understand the needs and concerns of employees.
• Recommends changes in policies and practices wherever employee needs are not being met.
• Receives, investigates and responds to employee complaints.

Human Resource Management Responsibility

• Monitors Human Resources practices at each facility to ensure compliance with employment laws and company

policies, and to ensure practices that maintain high morale and staff retention to include effective communication,

prompt problem resolution, proactive supervisory practices, and maintaining a proactive work environment.

• Organizes the functions of the nursing home in collaboration with the facility administrator through appropriate

departmentalization and the delegations of duties; establishes formal means of accountability.

• Conduct continuing education programs and special in-service training to direct reports and special in-service for all

staff; Maintains frequent, daily, informal interaction and provides positive feedback to staff while they are working;

Maintains open door policy in dealing with staff.

• Recruits, interviews, hires, and trains administrators and regional leadership; Reviews direct reports performance at

least once annually and makes recommendations for merit increases and initiates performance plans for employees

who fail to meet company expectations.

• Follows, interprets, and enforces corporate personnel policies.
• Communicates clearly and responsively on issues arising in the facility to decision makers who are outside of the

facility and follows-up to minimize negative impact of issues.

• Schedules interdepartmental and departmental meetings, where appropriate, to maintain liaison between the

leadership and facility personnel.

Job Description Manual

• Manages all region’s internal relationships according to the company policies, procedures, directives, etc.
• Manages direct reports according to the same standards expected of them in managing their subordinates including,

but not limited to, counseling, communicating disciplinary action, granting time-off, calling off-duty employees

and/or transferring employees to cover staffing, assigning employees to specific work tasks, training, orienting,

interviewing and screening prospective employees, disciplining employees who violate policies, adjusting complaints,

evaluating performance, rewarding, approving time off and overtime, and attending to other supervisory duties as

required.

• Terminates/redeploys staff for performance related issues or for unethical behavior.
• Ensures all supervisors are trained in and implement The Company policies and procedures including, but not limited

to, Personnel Policy Manual, Policy & Procedure, and Employee Handbook.

• Attends and participates in all Human Resources Workshop.

Management Responsibilities

• Develops organizational strategies by contributing information, analysis, and recommendations to strategic thinking

and direction; establishing functional objectives in line with organization objectives.

• Establishes operational strategies by evaluating trends, establishing critical measurements; determining production,

productivity, quality, and customer-service strategies; designing systems; accumulating resources; resolving problems;

implementing change.

• Develops financial strategies by estimating, forecasting, and anticipating requirements, trends, and variances; aligning

monetary resources; developing action plans; measuring and analyzing results; initiating corrective action; minimizing

the impact of variances.

General Responsibilities

• Attends and participates in scheduled training, educational classes, and meetings to maintain current certification as

applicable; Attends and participates in in-service training as mandated by regulatory agencies and company policy.

• Adheres to work schedules in completing and performing assigned tasks; completes all assigned tasks in a timely

manner as instructed by the direct supervisor.

• Meets acceptable center attendance requirements; notifies facility before late arrival to or absence from work

according to established center policy.

• Cooperates with other facility personnel to ensure that services can be adequately maintained to meet the needs of

residents; creates and maintains an atmosphere of warmth, personal interest, and positive emphasis, as well as a calm

environment.

• Adheres to established employee policies.
• Adheres to established dress code.

Customer Service Responsibilities

• Models customer service principals throughout the center and promotes appreciation of our customer’s needs with

every employee.

• Communicates customer discharge objectives and expectations to center department heads and team.
• Role model’s superior customer service
• Presents professional image through appearance, behavior and speech.
• Establishes realistic expectations for service levels with families, patients and referral sources

Residents Rights

• Understands, upholds and promotes the rights of the residents.
• Ensures residents can exercise rights without interference, coercion, discrimination, or reprisal from the facility.
• Ensures protected health information is kept confidential.
• Ensures patient concerns/complaints are responded to with tact and urgency.
• Reports allegations of patient abuse, neglect and/or misappropriation of patient property.
• Coordinates effective communication with Patients and Companions by assuring all arrangements for providing

interpreters and/or other auxiliary aids and services needed by Patients and Responsible Party are made, including

scheduling interpreters through outside agencies and scheduling staff interpreters, if any; and ensuring appropriate

maintenance, repair, replacement and distribution of auxiliary aids.

Job Description Manual

Safety and Sanitation

• Follows established safety policies and procedures.
• Identifies and corrects safety hazards; reports safety concerns as required.
• Observes safety needs of patients as indicated in care plan.
• Wears and/or uses safety equipment and supplies when indicated and properly trained to use.
• Demonstrates job-specific knowledge of fire and disaster preparedness during drills or actual situations.

Staff Development

• Attends and participates in scheduled in-service training, educational classes and meetings to maintain current