Genesis HealthCare is one of the leading providers of healthcare services from short-term to long-term care and a wide variety of living options and professional clinical services. We are changing how care is delivered by bringing together people like you -- passionate, highly skilled and motivated to make a difference.
Why Genesis?
We improve the lives we touch through the delivery of high-quality healthcare and everyday compassion!

• We Care Deeply about YOU! Guided by our Core Values, Code of Conduct and Ethics program, we foster a culture of care and compassion. We focus on improving the quality of care through creativity and innovation, honesty and integrity in all we do.
• We Develop YOU! We provide career ladders, education and training opportunities so you can build a long and successful career with Genesis.
• We Appreciate YOU! We value your contributions to the Genesis mission and vision and instill an environment of teamwork and enjoyment in working together. We recognize and celebrate our shared successes.
• We are Committed to YOU! We know you are the vital link between Genesis, our patients and residents! We inspire you to be your best self.
• We Protect YOU! We take great pride in meeting or exceeding CDC and CMS standards.

The Case Manager ensures the collaborative process of assessment, planning, facilitation and advocacy for options and services to meet the patient's health needs with quality and cost-effective outcomes as the priorities.
POSITION HIGHLIGHTS

• Report to the Market Clinical Reimbursement Manager
• Monitor patients' case throughout stay to ensure utilization of services are in accordance with plan of care and minimize financial risk to patient and center.
• Verify and communicate current, accurate and complete clinical information to payer from patient Pre-Admission through Concurrent Review using standard and plan review forms to justify clinical necessity according to payer review schedule.
• Act as an account liaison on Genesis' behalf with our plan providers and identifies opportunities for quality and performance improvement.
• Ensure the Interdisciplinary Team implements services in the patient plan of care subject to contract terms and case negotiations in order to minimize overutilization or under-utilization of services and unreimbursed claims.
• Negotiate for appropriate continuation of length of stay or extension of services and appropriate Level of Care (what is covered/what is not covered) and associated rates.
• Obtain payer authorization for recommended treatments, procedures, supplies, equipment and medications and all exclusions.

SHAREMC13
Qualifications:

• High school degree with college coursework is preferred.
• Experience with medical terminology is required.
• Prior experience in utilization review, case management or discharge planning is preferred.*Experience in rehabilitation nursing, acute care and/or the insurance field is preferred.*Prior experience in case management which includes service to short/long term facility based clients is preferred.*Advanced knowledge of third party reimbursement, insurance coverage and contract requirements is preferred.To protect the health and safety of our patients, residents, employees, family members, and the communities we serve, Genesis has implemented a universal COVID-19 vaccination requirement for employees, care partners and onsite vendors. Other Info

Position Type: Full Time
Job City: Columbus
Requisition Number: 440632
Not Stated