What are the responsibilities and job description for the Case Manager position at Guided Care?
Description:Guided Care is seeking a full time Case Manager. 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.Requirements:• 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 eachrequest 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 formanaging 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 plansand states to ensure upkeep the Guide to Obtain Authorizations.• Informs supervisor of prior authorizations pending over 72 hours to assist in escalation andclient satisfaction.• Reviews prior auth packet for completeness and is responsible for ensuring correctdocumentation 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 theclient does not incur provider liable days.
Salary : $60,000 - $70,000