National Health Care Associates, provider of high-quality long-term care and short-term rehabilitation services with skilled nursing facilities in the Northeast U.S., is seeking a Regional Case Manager. This is a fantastic opportunity for the right candidate to join one of the premier healthcare organizations in the Northeast!

The Regional Case Manager will work remotely with periodic travel to our Centers in the assigned region.

Position Summary: Serve as an advocate for short term, skilled patient population by conducting concurrent chart reviews and collaborating with the treatment team and social work department to facilitate a patient-centered case to present to the managed care insurance along with supporting documentation of medical necessity for continued stay approval to ensure the patient is medically stable, and at a discharge level of function with a safe discharge plan in place to promote success in the community and limit readmissions.

Sampling of Responsibilities

• Understand and be familiar with managed care contracts including criteria for LOC, inclusions, and exclusions.
• Foster positive relationships with participating Health Plans.
• Be proficient with multiple computer programs and insurance portals.
• Establish and nurture relationships with the insurance case manager or SICC.
• Assist and provide guidance for appeals.
• Educate center teams on cost containment and insurance medical necessity criteria.
• Complete business office communications proficiently for level and payor source changes and send to the center teams.
• Attend weekly Medicare meetings in person when appropriate.
• Collaborate and assist A/R on denied claims as needed.
• Participate in insurance training as needed.
• Be familiar with insurance coverage and contract requirements, maintain a current and comprehensive knowledge of third party payers, insurance reimbursement and the appeal and denial process

Education and Experience

• RN, LPN, LSW, Therapist, etc. with knowledge and understanding of Managed Care.
• Background in Case Management, Concurrent Review, Utilization Management is desirable.
• Experience/knowledge of Medicare.
• Experience in skilled nursing/nursing home setting, insurance co's is desirable.

Please visit our website at www.nathealthcare.com

What makes National Health Care Associates (NHCA) a GREAT fit for you?

When you join NHCA, you become part of a premier provider of short-term rehabilitation, skilled nursing, and post-hospital care. Our care team of more than 5,000 employees in six states cares for patients throughout the Northeast. We built a comprehensive network of services for each of our 35 centers, carefully designed to address the individual needs of every person entrusted to our care.

Our mission is to provide our residents and their families with superior care delivered by staff dedicated to the principles of kindness, compassion, service, and excellence in an environment where individuality, dignity, and value of those who are served, as well as those who serve, is nurtured and appreciated. We believe that life, at all stages and with all of its challenges, is a precious gift to be shared and celebrated. It is our privilege to participate in the lives of our residents, their friends and families by offering them not only physical but emotional care, comfort, and support.

At National Health Care Associates...We Touch People's Lives.

Diversity, Inclusion, & Engagement at National Health Care Associates:

At National Health Care Associates, we not only accept difference, we promote it, we embrace it, and we thrive on it for the betterment of our patients, our employees, and our culture.

We are proud to be an equal opportunity workplace and an affirmative action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status or any other status protected under applicable law.

All candidate applications are kept confidential.

Avoid being a victim of Job Scams

Please be advised that National Health Care Associates, Inc. and its affiliates will never ask you to pay for a job offer, placement fee, office equipment or training. Such information is typically requested to be completed on forms while you are in our facility or through our career site. Unfortunately, scammers may impersonate our employees while targeting job seekers. Please remain vigilant and aware that someone may reach out to hire you but may be a bad actor trying to take your personal information and money. Protect yourself by accessing forms and contact information through known company websites instead of email or text message links. Learn more by searching “FTC.gov Job Scams.”