Sr Care Manager Unihealth

PruittHealth Position

Screens appropriate referral and coordinates admission process. Coordinates services with providers, billing reconciliation. Provides outreach to community referral sources.

Essential Job Functions, Duties, and Responsibilities:

• Markets their area for awareness of SOURCE and PRN meetings with new PCPs.
• Completes all new admission paperwork for signed forms and in-home assessments.
• Participates in team meetings with Medical Director each week and presents all new admits, annual assessments, hospitalizations, Home Health admits and discharges, repeat variances, people with potential for discharge and actual discharges and situations threatening someone's health or functional status.
• Completes quarterly home visits and quarterly PCP visits with all requirements for each completed.
• Completes variances at any given time when a care path goal is not met. Must list the variance plan of actions and must have follow up to resolution or a repeat variance with a new plan outlined. Tracks all hospital/ER visits by completing paperwork, requesting records and communicating with hospitals.
• Coordinates with outpatient therapy centers, home health agencies, healthcare centers (if short term), and rehab by working with their staff and completing skilled care track form. Makes PRN contacts and home visits if needed to assess member needs. Reevaluates member needs for service, level of service and evaluates service effectiveness.
• Uses own vehicle for travel. Completes mileage and time sheets for reimbursement. Arranges transportation as required. Is available for internal record audits as requested. Completes annual reassessments in member's homes. Reviews medicine for appropriateness.
• Attends trainings when required. Trains new hires as needed. Is available for on-call rotation as designated by CMS referrals. Communicates with regulatory and DFACS agencies for APS and CPS referrals.

Training, Skills, and Experience Requirements:

• Current State License as a Registered Nurse, RN

Family Makes Us Stronger. Our family, your family, one family. Committed to loving, giving, and caring. United in making a difference.

We are eager to connect with you! Apply now to get started at PruittHealth!

As an Equal Employment Opportunity employer, all qualified applicants will receive consideration without regard to race, color, religion, sex, national origin, disability, or veteran status.