Regional Case Manager

Managed Care Case Manager

Summary/Objective: Responsible for facilitating interdisciplinary plans and assuring progress reports are completed and provided to payor as required. Serves as liaison between patient, physician, care team members, payor, and the discharge planner by coordinating, monitoring, and communicating patient’s progress and cost evaluation and assisting with coordination to the next level of care.

Essential Functions

• 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 nextlevel of care.
• Obtains accurate information from physicians, patients, and payor source regarding theexpected 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 AccountManagement 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/professionalorganizations, etc. to understand the need for program services and to communicate servicesoffered 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.
• Monitors census and profitability of managed care patients.
• Assists accounts receivable bookkeeper to assure accurate billing and timely collections by adhering to case management procedures.
• Assists with the appeal process when appropriate and upon request.
• Maintains all operational documentation as indicated by Corporate and Facility management
• Participates in developing and updating case management policies and procedures and maintains required records and reports.
• Coordinates work between departments
• Maintains confidentiality of necessary information
• Additional duties assigned upon company needs.

Benefits And Perks:

• Opportunities for career advancement within a dynamic healthcare environment.
• Comprehensive health, dental, and vision insurance coverage for you and your family.
• Company-paid life insurance policy.
• Flexible Spending Account (FSA) and Health Savings Account (HSA) options.
• Generous paid time off (PTO) policy, including vacation, sick leave, and holidays.
• Tuition reimbursement program to support continued education.