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PRN Case Manager - Skilled Nursing Facility

Company: ProMedica Senior Care
Location: Bonita Springs
Posted on: January 15, 2022

Job Description:

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 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 therapy services
  • Validates appropriate benefits available for services requested
  • Pursues required authorization for services recommended by our therapist
  • 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 addressed
  • 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.
    Location

    420 - ManorCare Nursing & Rehabilitation Center - Naples, Florida

    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.

Keywords: ProMedica Senior Care, Bonita Springs , PRN Case Manager - Skilled Nursing Facility, Executive , Bonita Springs, Florida

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