Spanish Speaking Hospice Case Manager

JOB DESCRIPTION SUMMARY

Responsible for coordinating hospice services for managed care patients which includes establishing and maintaining the patient’s plan of care, establishing and maintaining positive relationships with managed care customers and related referral sources, and negotiating service agreements.

ESSENTIAL JOB FUNCTIONS/RESPONSIBILITIES

• Coordinates hospice services for managed care patients, assists with the establishment of the plan of care in coordination with the physician and insurance Case Managers, and ensures a seamless transition to hospice.
• Collaborates with inpatient utilization review departments and managed care organizations to facilitate safe, early inpatient discharge.
• Verifies insurance coverage and obtains initial authorizations for services and seeks reauthorization for ongoing or additional services.
• Works with Clinical Supervisors and staff clinicians to gather, collate, and report patient care summary information to managed care Case Managers.
• Promotes maximum third party reimbursement through price negotiations with managed care organizations within the established financial, credit, and contractual parameters.
• Maintains comprehensive working knowledge of managed care contractual relationships and ensures that patients are admitted and services are delivered in accordance with contract provisions.
• Works with members of the billing team to ensure that managed care customers are billed according to managed care organization agreements.
• Establishes and maintains positive working relationships with current and potential managed care customers.
• Promptly responds to managed care customer’s requests and concerns.
• Assists in building community, customer, payer and patient perceptions of Hospice Agency as a high quality provider of services.
• Maintains comprehensive working knowledge in the field of managed care and shares information with appropriate organization personnel.
• Maintains comprehensive working knowledge of community resources and assists customers in accessing community resources should services not be provided by Hospice Agency.

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.

POSITION QUALIFICATIONS

• RN or LVN with current licensure to practice professional nursing in California.
• Graduate of National League for Nursing accredited school of nursing.
• At least three (3) years’ experience in health care managed care coordination preferably in hospice or similar operation.
• Complies with acceptable professional standards and practice.
• Ability to market aggressively and deal tactfully with customers and the community.
• Knowledge of corporate business management and managed care environment.
• Demonstrates good communications, negotiation, and public relations skills.
• Demonstrates autonomy, organization, assertiveness, flexibility and cooperation in performing job responsibilities.

Job Type: Full-time

Salary: $30.00 - $40.00 per hour

Medical specialties:

• Hospice & Palliative Medicine

Schedule:

• Day shift
• Monday to Friday
• On call
• Weekends as needed

Work setting:

• Hospice

Ability to commute/relocate:

• Encino, CA 91316: Reliably commute or planning to relocate before starting work (Required)

Experience:

• Nursing: 3 years (Preferred)
• Case management: 3 years (Preferred)

License/Certification:

• RN (Preferred)
• LVN (Required)

Willingness to travel:

• 25% (Preferred)

Work Location: In person

Job Type: Full-time

Pay: $30.00 - $40.00 per hour

Expected hours: 40 per week

Benefits:

• Dental insurance
• Health insurance

Medical specialties:

• Hospice & Palliative Medicine

Schedule:

• Monday to Friday

Work setting:

• Office

Ability to commute/relocate:

• Encino, CA 91316: Reliably commute or planning to relocate before starting work (Required)

Experience:

• Nursing: 1 year (Required)
• Case management: 1 year (Required)

License/Certification:

• RN (Preferred)

Willingness to travel:

• 25% (Preferred)

Work Location: In person