Case Manager - Skilled Nursing Facility
HCR ManorCare provides a range of services, including skilled nursing care, assisted living, post-acute medical and rehabilitation care, hospice care, home health care and rehabilitation therapy.
Responsible for coordinating with facility staff regarding patient needs for out-patient (Part B) therapy services and obtaining authorization for those specific required services from various health plan organizations. Continue to coordinate care, monitor progress and support center teams with the transition to custodial care when appropriate via effective communication with respect to approvals obtained by the patient’s health plan.
In return for your expertise, you’ll enjoy excellent training, industry-leading benefits and unlimited opportunities to learn and grow. Be a part of the team leading the nation in healthcare.
Case Manager Responsibilities
Coordinates with facility teams regarding requests for Part B therapy services
Validates appropriate benefits available for services requested
Pursues required authorization for services recommended by our therapist
Communicates accurate authorization information to care team and coordinates patient's smooth transition to the next level of care when appropriate
Completes timely audits to ensure all requests have been addressed
Generates monthly reports summarizing metrics associated with Part B services including, but not limited to, volume, length of stay, revenue, A/I ratio, denials/adjustments, audit results
Identifies areas of opportunity within current process or breakdowns in communication to facilitate improvement
Participates in business review meetings as directed by their supervisor
Minimum two years medical, clinical, concurrent review or pre-certification case management experience preferred. 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, written, and organizational communication skills required.
College degree in the health & human service field required. Current, active, and unrestricted licensure or certification in a health or human services discipline preferred.
Minimum two (2) years experience in medial case management. Comprehensive knowledge of workers' compensation, insurance, and managed care, required. Ability to negotiate coverage and provide complete and timely case mgmt reports, required. Prior experience with an insurance company, private case mgmt. Company, or HMO, preferred. Familiarity with long- term care and/or sub acute care, useful. Strong oral and written communication skills, required.
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