PRN Case Manager - Skilled Nursing Facility
Company: ProMedica Senior Care
Posted on: January 15, 2022
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 SummaryResponsible for coordinating with
facility staff regarding patient needs for out-patient (Part B)
therapy services and obtaining authorization for those specific
required services from various health plan organizations. - -
Continue to coordinate care, monitor progress and support center
teams with the transition to custodial care when appropriate via
effective communication with respect to approvals obtained by the
patient 's health plan.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. -PRN Case
Manager, Part B -Responsibilities
- Coordinates with facility teams regarding requests for Part B
- Validates appropriate benefits available for services
- Pursues required authorization for services recommended by our
- Communicates accurate authorization information to care team
and coordinates patient's smooth transition to the next level of
care when appropriate
- Completes timely audits to ensure all requests have been
- Generates monthly reports summarizing metrics associated with
Part B services including, but not limited to, volume, length of
stay, revenue, A/I ratio, denials/adjustments, audit results
- Identifies areas of opportunity within current process or
breakdowns in communication to facilitate improvement
- Participates in business review meetings as directed by their
supervisorRequirementsMinimum two years medical, clinical,
concurrent review or pre-certification case management experience
preferred. Comprehensive knowledge of workers' compensation,
insurance, and managed care required. Ability to negotiate coverage
and provide complete and timely case management reports required.
Prior experience with an insurance company, private case management
company or HMO preferred. Familiarity with long- term care and/or
sub-acute care useful. Strong oral, written, and organizational
communication skills required.
420 - ManorCare Nursing & Rehabilitation Center - Naples,
College degree in the health & human service field required.
Current, active, and unrestricted licensure or certification in a
health or human services discipline preferred.
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,
Keywords: ProMedica Senior Care, Cape Coral , PRN Case Manager - Skilled Nursing Facility, Executive , Naples, Florida
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