Health Insurance Case Manager

• Associate degree in the health amp; human service field preferred.
• Current, active, and unrestricted licensure or certification in a health or human services discipline preferred
• Minimum two (2) years’ experience in medical case management 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 and written communication skills, required.

• Nursing background strongly preferred
• Negotiates appropriate level of care within contract terms with the payor case manager
• Utilizes Letter of Agreement for non-contracted arrangements
• 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
• Develops referrals from hospitals' social service and discharge planning departments, physicians, case managers, insurance companies and other referral sources
• Participates in Marketing Action Plan and Key Account Meetings and assumes Key Account Management responsibilities as directed by their supervisor.
• Visits hospital social workers, physicians, hospital discharge planners and administrators, attorneys, support organizations (i.e., oncology, stroke, head injury, etc.) civic/professional organizations, etc. to understand the need for program services and to communicate services offered which meet these needs to obtain referrals of patients
• Invites referral sources to nursing center and presents programs and presentations to support groups, insurance companies, self-insured industry, physicians, etc.
• Networks through case management organizations by attending community meetings regularly.
• Acts as a liaison between payors and decision makers facilitating a smooth transfer of information
• Assists in program evaluation as requested.
• Maintains primary focus of census development and revenue enhancement
• Provides documentation of contract or payor information on a timely basis to treatment team and business office billing staff, following case management policies
• Monitors that records pulled for insurance provider requests are complete and appropriate

If you are a highly motivated and experienced Case Manager with a passion for providing excellent patient care, we encourage you to apply for this exciting opportunity.