Weekend Case Manager

Guided Care is seeking a full time Weekend Case Manager, to provide coverage for our Prior Auth and Clinical Case Management teams. This individual obtains prior authorizations and authorization extensions for clients with the goal of ensuring insurance coverage for patient stays and low turnaround times for auth obtainment. The Case Manager reports to their Supervisor of Case Management. The schedule is: 8-6 EST or 9-7 EST on Saturdays, Sundays, Tuesdays, and Wednesdays.

Key Results Area

• Puts forth best efforts to learn and understand the full training provided upon onboarding.
• Actively responds to clients’ authorization requests within 20 minutes of receipt per each request throughout the day and provides updates to clients minimum three times a day on pending cases.
• Maintains a full understanding and data input accuracy of Guided Care software for managing client authorization requests.
• Maintain a high level of customer service and professionalism in all methods of communication.
• Complete census verification before or by 11 AM.
• Updates supervisor of any new developments on prior auth process specific to health plans and states to ensure upkeep the Guide to Obtain Authorizations
• Informs supervisor of prior authorizations pending over 72 hours to assist in escalation and client satisfaction.
• Reviews prior auth packet for completeness and is responsible for ensuring correct documentation is submitted to insurance. Is responsible for ensuring only clinical documentation required by insurance is submitted. Maintains no more than 10 missing levels post 10 days of admission, with the goal to average 0. Follow up with insurance for determination on all NRDs within 72 business hours, to ensure the client does not incur provider liable days.

• High School Diploma or GED.
• 3 years of experience submitting obtaining authorizations in a healthcare setting.
• Skilled nursing admissions or business office experience preferred.
• Independent and self-motivated.
• Innovative and detail-oriented professional with strong research and organizational skills.
• Thrives in a fast paced, high-pressure environment.
• Strong time management with a proven ability to meet deadlines.
• Solid collaborative skills with team and clients.
• Ability to work remotely and autonomously.
• Ability to establish and maintain positive relationships.

The schedule is: 8-6 EST or 9-7 EST on Saturdays, Sundays, Tuesdays, and Wednesdays.