Title Care Coordination and Utilization Manager   EOE Statement We are an equal employment opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status or any other characteristic protected by law.   About the Organization ProMedica is a mission-based, not-for-profit health and well-being organization headquartered in Toledo, Ohio. It serves communities in 28 states. The organization offers acute and ambulatory care, an insurance company with a dental plan, and post-acute and academic business lines. The organization has more than 45,000 employees, 11 hospitals, 2,100+ physicians and advanced practice providers with privileges, 1,000+ healthcare providers employed by ProMedica Physicians, a health plan, and senior care services. ProMedica`s senior care division operates 330+ assisted living facilities, skilled nursing centers, memory care communities and hospice, palliative and home health care agencies. Services are provided in 26 states and the majority now operate under the ProMedica brand and Arden Courts. Over the next few months, the rest of our entities under the Heartland and ManorCare names will rebrand to ProMedica. Driven by its Mission to improve your health and well-being, ProMedica has been nationally recognized for its advocacy programs and efforts to address and lead in social determinants of health, champion healthy aging and cultivate innovative solutions. For more information about ProMedica senior care services, please visit www.promedicaseniorcare.org.   Specific Job Detail None Specified  Sign-on Bonus None Specified  Description ProMedica Senior Care provides a range of services, including skilled nursing care, assisted living, post-acute medical and rehabilitation care, hospice care, home health care and rehabilitation therapy. Job Summary The Care Coordinator and Utilization Manager (CCUM) plays an integral role in optimizing the plan of care for Managed Care patients. The CCUM is responsible for the timely compilation, review and submission of medical information relating to the post-acute skilled stay. By serving as the liaison between the patient, physician, interdisciplinary care team members, and the payer; this position coordinates, monitors, advocates and communicates the patients progress and cost evaluation while assisting with and coordinating an efficient and smooth coordination to the next level of care. In return for your expertise, you’ll enjoy excellent training and unlimited opportunities to learn and grow. Be a part of the team leading the nation in healthcare. Care Coordination and Utilization Manager Responsibilities Maintains a strong working knowledge of all managed care contracts for their assigned area of responsibility. Negotiates appropriate levels of care for contracted and non-contracted terms with the payor case manager. Communicates information to care team and coordinates patient's smooth transition to the next level of care. Obtains accurate information from physicians, patient, and payor source regarding the expected discharge plan and communicates this information to the interdisciplinary team. Complies with key department expectations for care coordination and utilization including: Manage assigned caseload efficiently and effectively utilizing time management skills. Reviews and ensures clinical documents for insurance provider requests are complete and accurate prior to submission. Complete continued stay reviews and update extended authorizations timely in addition to coordinating and monitoring length of stay for alternative payor models.  Enter timely and accurate documentation in MCO portals as required. Act as a liaison between payors and interdisciplinary team facilitating a smooth transfer of information. Manage the care plan throughout the continuum of care as a single point of contact   Educational Requirements College degree in the health & human service field required. Current, active, and unrestricted licensure or certification in a health or human services discipline preferred.   Position Requirements Minimum two (2) years experience in medial case management. Comprehensive knowledge of workers' compensation, insurance, and managed care, required. Ability to negotiate coverage and provide complete and timely case mgmt reports, required. Prior experience with an insurance company, private case mgmt. Company, or HMO, preferred. Familiarity with long- term care and/or sub acute care, useful. Strong oral and written communication skills, required.   Location 481 - ProMedica Skilled Nursing and Rehabilitation - Allentown, PA   This position is currently not accepting applications. To search for an open position, please go to http://hcrNews.appone.com WE ALSO RECOMMEND Other Jobs Within Same Category Liaison RN - Hospice in Westmont, IL Posted on: 7/5/2022 [Apply Now] Liaison RN - Hospice in Ft. 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