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Regional Insurance Case Manager - RN or LPN 

About the Organization CommuniCare Family of Companies is a privately held, multi-faceted healthcare management company in operation since 1984 that specializes in nursing homes, assisted living facilities and rehabilitation units. Our company's historic passion for excellence is evident in every facet of our service continuum. We are leaders in the long-term care industry and operate over 40 facilities across Ohio, Pennsylvania, Maryland and Missouri, employing more than 7,000 dedicated care personnel. We're excited about your interest in joining CommuniCare and your desire to uphold our mission of Caring with Purpose and Caring with Pride.  
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Regional Insurance Case Manager - RN or LPN

Due to continued growth, CommuniCare Health Services is recruiting a Regional Insurance Case Manager for the Cleveland, OH region!

The position of Regional Insurance Case Manager is responsible for a case load of managed care patients and concurrent reviews for multiple facilities (Candlewood, Cityview, Grand Pointe and other centers to be assigned). The position coordinates, monitors, and communicates patients' progress and cost evaluation and assists with coordination to the next level. In addition, the position must partner with operations, marketing, clinical reimbursement, therapy, finance, and billing to implement managed care processes and procedures according to CommuniCare policies and procedures.

The qualified candidate will be a State licensed RN or LPN with 3 or more years experience in Long Term Care, preferably working directly with Managed Care. 2+ years medical case management experience required. Candidates must have excellent communication skills, strong analytical skills, and good computer skills. PCC experience a plus.

Job duties include:

  • Act as liaison between facility, insurance companies, resident/family, Rehab, and other care providers to communicate patient's needs to insurance providers while representing the facility and patient's interests.
  • Establish relationships with MCO's Case Managers by telephone or on-site.
  • Oversee case management services for assigned Managed Care patients to ensure appropriate care is rendered and appropriate reimbursement is obtained.
  • Work with Pre-Certification designee to ensure smooth admission to center. Obtain re-certifications and ensure timely coordination of delivery of NOMCC.
  • Negotiate and document, for billing purposes, the level of care and any exclusions.
  • Complete in an accurate and timely fashion all required documentation associated with rates, levels of care, and exhausts as required by CommuniCare or MCO.
  • Attend MDT meeting in person or by telephone and be prepared to lead conversation regarding MCO patient's treatment and discharge plan.
  • Participate in all assigned clinical and operation meetings.
  • Assist with audits by MCO's in conjunction with the Corporate Compliance Department.
  • Maintain current knowledge of Managed Care Contracts' guidelines and outliers to ensure care is provided and billed appropriately and to serve as subject matter expert.
  • Travel between centers in region as needed and directed by Corporate Director of Managed Care and Case Management.

At CommuniCare, you will enjoy an excellent salary and an outstanding benefits package in a pleasant, team environment. Qualified candidates, please submit your resume and letter of interest for confidential consideration.

 
Position Requirements
  • Graduate of an accredited school of nursing, LPN or RN
  • Valid Nursing license in the State employed
  • 3+ years experience in Long Term Care, preferably working directly with Managed Care
  • 2+ years medical case management experience (insurance, worker's comp, and/or managed care)
  • Strong oral and written communication skills and interpersonal skills
  • Strong analytical, problem solving, and time management skills
  • Ability to use personal computers and proficiency in application software such as Microsoft Excel and Word
  • PCC experience a plus
 
Full-Time/Part-Time Full-Time  
Location Cleveland Region  
Shift -not applicable-  
Experience Level 3 or more years in Long Term Care, preferably working directly with Managed Care  
Education Level RN or LPN license required  

This position is currently not accepting applications.

To search for an open position, please go to http://CommunicareHealth.appone.com



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