Your Job

The Case Manager will have an innate ability to provide outstanding customer service to both the patients, families and referral sources. You will be responsible for part B authorizations.

Your Qualifications

Experience in long-term or acute.

Experience in case management or disease management.

Your Responsibilities

Responsible for the management of therapy Part B authorizations

Responsible for ensuring the continuity of care utilizing the appropriate resources within the parameters of established contracts and resident health plan benefits

Attains prior authorization for Part B therapy services as directed

Alert appropriate management team members regarding late or missing documents required for authorization approval

Provide excellent customer service to patients, families and referral sources

Ensure the members are receiving treatment from the therapy department that is clinically appropriate

Direct line of communication to external insurance Case Managers

Complete daily tracking log with updated status of authorization through approval

Continued follow up with the Insurance/Medicaid representatives until request approved/denied

Request and obtain continued authorizations while member is receiving therapy

Submit initial therapy evaluations, doctors order and therapy notes to external Insurance/Medicaid providers within 24 hours

Communication of authorization approvals and denials to management team

Adhere to professional standards as outlined by protocols, rules and regulations

Performs any miscellaneous work assignments as may be required

Able to analyze various types of data reports

Outfield Healthcare Partners provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.