Insurance Case Manager

Full Time 32 hours

Position Summary : Interacts with representatives of managed care companies to case manage the continuation of stay of managed care residents. Manage chart review, analyze skill level in in collaboration with the interdisciplinary team. With residents and families, communicates patients progress, obstacles, and insurance status.

POSITION REQUIREMENTS - Education / Experience

LPN or Social worker preffered.

• Minimum of two (2) years’ experience in a long-term or post-acute setting.
• Medicare and / or Managed Care regulation experience.
• Ability to read, write and comprehend English; ability to follow oral and written instructions.
• Fluent knowledge of the MS Office suite and other office equipment.
• Ability to work hours as scheduled based on the requirements of the position assignment.

Essential Functions

1. Manages the Medicare Notice of Non-Coverage process including but not limited to staying current with regulatory changes, timely notification of patients / responsible party, instructing facility staff in in required tasks, etc.

2. Completes managed care assessment reports.

3. Communicates pertinent information as needed with managed care company representatives.

4. Maintains managed care contracts and ensures facility adherence to contractual stipulations in the delivery of care.

5. Ensures managed levels of care align with patient’s individualized plan of care and seeks to reconcile noted exceptions (i.e., high-cost pharmaceuticals, wound vacs, etc.)

7. Provides feedback to facility concerning resident / family satisfaction.

8. Attends pertinent meetings and programs (e.g., Medicare / Care Plan).

9. Participates in 72-hour meetings and collaborates with Social Services pertaining to discharge planning.

10. Oversees and assists with Managed Care and Medicare Appeals to ensure medical record is sent.