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.
Oneida Center for Rehabilitation and Healthcare. Formerly known as Focus Utica for Rehabilitation and Healthcare, Oneida Center is a 120-bed rehabilitation and skilled nursing facility located in Utica, New York. Our pledge to the community, our residents and staff is to provide post-acute care in a manner that sets the standard of excellence and strives to meet and/or exceed the expectations of our residents, staff, and all we come in contact with. Services at Oneida Center include Skilled Nursing, Respite, Hospice, and Post-acute Rehabilitation and are affiliated with an Assisted Living Program and Adult Day Care. We endeavor to embrace our residents in times of crisis and assist them to leave and/or live here with a sense of well-being, individuality, and independence.