Regional Managed Care, Case Manager

Company: Atrium Centers Inc.
Location: Columbus
Posted on: November 26, 2022

Job Description:

Employee Owned Company that is committed to each other's success and the wellbeing of others.:Looking for RN or LPN that has experience as a Managed Care, Case Manager.:#INDOJSUMMARY OF POSITION: Responsible for the accurate assessment of referrals through medical record review prior to skilling managed care patients. This include review medical needs, discharge considerations, payment sources, and patient/family expectations at the time of admission. Build and foster relationships with insurance case managers and prior authorization departments.ESSENTIAL DUTIES AND RESPONSIBILITIES:---Negotiate per diem or skilled level within contract guidelines---Responsible for precertification and recertification of skilled patients---Coordinate assessment with entire medical team for objectives, goals, and plans for residents to achieve---Communicate with payer case management ongoing to ensure clinical information conveys skilled need utilizing Interqual criteria and following Medicare guidelines---Interact and coordinate with rehab team, MD, SW, and nursing the necessary information required for a weekly report and DC planning---Documentation of insurance communications maintained to ensure payment---Assign appropriate levels of care based on needs of patient---Educate facilities on skilled documentation and best practices for Managed Care---Communicate benefit information to the facility team timelyKNOWLEDGE:---Knowledge of principles and processes for providing customer and personal services. This includes needs assessment, meeting quality standards for services, and evaluation of customer satisfaction.---Knowledge of patient chart review to determine clinical needs and facility capabilities.---Knowledge of, or ability to learn, reimbursement programs from payer sources.---Knowledge of managed care referral process.---Knowledge of, or ability to learn input into company EHR.---CMS Medicare Chapter 8 GuidelinesSKILLS:---Effective verbal, written, and communication skills.---Flexible and adaptive to changing work environment---Using logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions or approaches to problems---Adept with technological, clinical and prioritization problem solving skills---Self-motivated and organized, able to function and meet goals independently---Ability to work in a multi-facility roleABILITIES:---The ability to communicate information and ideas in writing so others will understand.---The ability to relate positively, effectively, and appropriately with residents, families, community members, volunteers, and other facility staff. Possess special interest in working with long-term care residents and the elderly.---The ability to attend meetings, conduct presentations, and meet prospective residents outside the facility.---Ability to work in a team atmosphere as well as autonomously---Support change and innovation---Delivering top notch customer service with quality resultsEDUCATION, EXPERIENCE, and TRAINING---Computer literacy skills (Microsoft Outlook, Microsoft Office, Internet)---Current RN or LPN License preferred. Experienced Social Services or Admissions in a long-term care setting considered.---Experience in managed care products and knowledge of Medicare requirements for skilled nursing approvals

Keywords: Atrium Centers Inc., Columbus , Regional Managed Care, Case Manager, Executive , Columbus, Ohio