Job Description

Case Manager

The Part-Time 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 patient's progress and cost evaluation while assisting with and coordinating an efficient and smooth coordination to the next level of care.

 

DUTIES:

  • 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.

Requirements:

  • Minimum two (2) years experience in medical 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.

CHC365 LB123

CHC

Application Instructions

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