Case Management Society of South Texas

Employment Opportunities

Heritage Home Health

TRISUN Healthcare

University Health System

Employer Name: Heritage Home Health
Employer Address: 4414 Centerview, Ste. 105, San Antonio, TX 78228
Employer Telephone: 210 377-1033
Employer Contact: Tonya Rose

Heritage Home Health is a growing Medicare Certified Home Health Agency.

Position Title: RN Case Manager, $3000 SIGN-ON BONUS!

Position Description: An RN Case Manager is responsible for:

• The oversight and coordination of care of his/her assigned patients.

  • This includes the completion of all types of OASIS assessments and coordination with other disciplines providing care to the patient.

Position Requirements:

• Currently licensed RN in Texas.

• Familiarity with Home Health ICD9 coding preferred.

• Home Health experience preferred.

Submit resume to: Tonya Rose

Posted 3/18/2008

University Health System
San Antonio, TX

Employer: University Health System
Employer Location: 4502 Medical Drive San Antonio, Texas 78229
Contact Person: Celia Govea
Contact Telephone Number: 210-358-4301
Position Title: Nurse Case Manager-Health Plans

Position Description:
Community First Health Plans Inc. is seeking a self-motivated Case Manager to join Management/Case Management team. The Case Manager is responsible for planning and evaluating options and services to ensure timely and cost effective health care for their members.

Position Requirements:

Posted 1/24/2008

Employer: TRISUN Healthcare, North, Central & South Texas Region,
Employer Location:  North, Central & South Texas Facilities

Position Title: Regional External Case Manager traveling to North, Central and South Texas region

ABOUT OUR COMPANY: TRISUN Healthcare is an Austin, Texas-based company that manages skilled nursing homes and assisted living facilities throughout Texas.
We are looking for an External Case Manager who is willing to travel to our facilities located in South. Central and North Texas.

Job Summary:

• Responsible for clinical and financial assessments of patients prior to admission.

• Facilitates interdisciplinary planning and assists with outcome report completion.

• Provides outcome data to payers and physicians on an as needed basis.

• Serves as care/cost liaison between patient, physician, care team members, payer, and discharge planner by coordinating, monitoring, and communicating patient's progress.

• Assists with coordination to most appropriate care level.

• Assists sub acute program director/administrator with census management.
  Participates in monthly bill review and A/R management.

Responsibilities:

Role in the Admissions Process-

• Assesses prospective patients to evaluate care needs and determine suitability for admission.

• Communicates with payers to determine and verify coverage and adequate funding for required patient services and length of stay.

• Calculates rate based on patient service needs and contracts with payer for care delivery.

• Communicates information to care team and coordinates patient's smooth transition into and through the treatment process.

• Obtains accurate information from physicians, patients, family and payers regarding the expected discharge plan, and communicates this information to the interdisciplinary team.

• Assists the sub acute program director/administrator with census management.

Internal Responsibilities:

• Ongoing assessment of the patient's clinical needs and determination of appropriateness for continued stay.

• Objective evaluation of the interdisciplinary plans, determining barriers, clarifying realistic goals, and identifying potential alternatives involving physician, team members, patient, and family.

• Initiation and implementation of plan modifications as necessary through monitoring and re-evaluation to accommodate changes in treatment or progress.

• Completion of progress reports to payer source as requested.

• Obtain documentation of patient specific contract and payer information with generation of confirmation and verbal/written agreement from the payer source detailing reimbursement rate and terms

• Coordination and planning of health care services to promote necessary outcomes and timely discharge.

• Assumption of the role as patient advocate to assure continuity of care and cost effective quality care with goal oriented outcomes.

Administrative Responsibilities:

• Provides documentation of contract or payer information on a timely basis to treatment team and business office and corporate staff

• Monitors, analyzes, and reports: census and case study progress data-
  Assists business office with accurate billing and timely collection

• Maintains appropriate documentation as indicated by corporate and facility management.

• Attends regional meetings, scheduled in-service programs, staff meetings and other center meetings and participation required committees

• Participates in developing and updating policies and procedures, and maintains required records and reports

• Coordinates work between departments; maintains confidentiality of necessary information.

• Thinks and acts logically, rationally, and with flexibility in order to meet all unusual occurrences of the job/

• Performs any miscellaneous work assignments as may be required

Referral Development Responsibilities:

• Develops referral sources (physicians, social workers, hospital discharge planners, insurance companies, managed care case managers) through outside sales calls with goal of generating increased managed care census.

• Completes referral development calls to various other referral sources (civic/professional organizations, home health agencies, families) in order to identify referral needs and to educate these referral sources regarding our services.

• Develops and presents CEU in-services to referral sources to promote familiarity with center and services.

• Arranges on-site tours for referral sources and family member's

Patient Satisfaction:

• Acts a liaison between payers and decision makers facilitating a smooth transfer of information

• Assists in program evaluation post discharge.

• Communicates discharge information to physician and payer with outcome data as appropriate.

• Accompanies patient to physician appointments.

• Assists patient and family with issues of reimbursement and understanding of policy values.

• Communicate patient and family concerns to sub acute program director/administrator.

Job Requirements:

• Education:

  • C.I.R.S. (Certified Insurance Rehabilitation Specialist) or C.C.M. (Certified Case Manager) preferred;

  • Registered Nurse-

• Experience:

  • Minimum three (3) years clinical experience and two (2) years experience in medical case management.

  • Comprehensive knowledge of workers' compensation, insurance, and managed care required.

  • Ability to negotiate coverage and provide complete and timely case management reports required.

  • Prior experience with an insurance company, private case management company, or HMO preferred.

  • Familiarity with long-term care and/or sub acute care useful.

  • Strong oral and written communication skills required.

Physical Demands: Work is primarily sedentary in nature, with exerting up to 10 pounds of force occasionally and/or a negligible amount of force frequently to lift, carry, push, pull, or otherwise move objects, including the human body.
Involves sitting, standing, and walking most of the time.

Travel: 50%-75%-

Working Conditions: Primarily inside with well-lit and well-ventilated areas.

Principal Contacts: Works closely with Regional Director of Operations, Administrators, sub acute program director, department heads, families, patients, physicians, discharge planners/social workers, insurance case managers, and self-insured employers-

General Requirements: Must be capable to execute all terms and conditions set forth in the HCR Manor Care Employee Handbook, including, but not limited to:

• Works in a safety conscious manner which insures that safe work practices are used in order not to pose a risk to self or others in the workplace

• Complies with company policies and procedures, and local, state, and federal regulations

• Adheres to policy on Drug Free Workplace

• Interacts in a tactful, diplomatic, and humanistic manner with residents, families, visitors, and co-workers to provide a safe, efficient, and therapeutically effective caring environment which insures the self-respect, personal dignity, rights, and physical safety of each resident and center guest

• Maintains a dependable attendance record and adheres to standards of cleanliness, grooming, hygiene, and dress code

Submit resume to: Cyndi Matula

Website: www.trisunhealthcare.com