This is a remote position but must be able to occasionally travel to our nursing homes in NYC.
The Case Manager plays an integral role in optimizing the plan of care for Managed Care patients and patients involved in various value-based care initiatives. The CM is responsible for the timely compilation, review and submission of medical information relating to the post-acute skilled stay. By serving as the liaison between the patient, physician, interdisciplinary care team members, and the payer; this position coordinates, monitors, advocates and communicates the patients progress and cost evaluation while assisting with and coordinating an efficient and smooth coordination to the next level of care.
- Maintains a strong working knowledge of all managed care contracts for their assigned area of responsibility.
- Negotiates appropriate levels of care for contracted and non-contracted terms with the payor case manager.
- Communicates information to care team and coordinates patient's smooth transition to the next level of care.
- Obtains accurate information from physicians, patient, and payor source regarding the expected discharge plan and communicates this information to the interdisciplinary team.
- Complies with key department expectations for care coordination and utilization including:
- Manage assigned caseload efficiently and effectively utilizing time management skills.
- Reviews and ensures clinical documents for insurance provider requests are complete and accurate prior to submission.
- Complete continued stay reviews and update extended authorizations timely in addition to coordinating and monitoring length of stay for alternative payor models.
- Enter timely updates as required. Act as a liaison between payors and interdisciplinary team facilitating a smooth transfer of information.
- 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.
- Knowledge of or experience working with ACO’s or other value based models is preferred.
- Strong oral and written communication skills, are required.