What are the responsibilities and job description for the Case Manager position at Centers Health Care?
Case Manager
The Case Manager plays an integral role in optimizing the plan of care for Managed Care patients and patients involved in various value-based care initiatives. The CM 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.
Duties:
- 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 updates as required. Act as a liaison between payors and interdisciplinary team facilitating a smooth transfer of information.
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.
- Knowledge of or experience working with ACO’s or other value based models is preferred.
- Strong oral and written communication skills, are required.
Location:
Utica, NY
About us:
Oneida Center for Rehabilitation and Healthcare. Formerly known as Focus Utica for Rehabilitation and Healthcare, Oneida Center is a 120-bed rehabilitation and skilled nursing facility located in Utica, New York. Our pledge to the community, our residents and staff is to provide post-acute care in a manner that sets the standard of excellence and strives to meet and/or exceed the expectations of our residents, staff, and all we come in contact with. Services at Oneida Center include Skilled Nursing, Respite, Hospice, and Post-acute Rehabilitation and are affiliated with an Assisted Living Program and Adult Day Care. We endeavor to embrace our residents in times of crisis and assist them to leave and/or live here with a sense of well–being, individuality, and independence.
Centers Health Care is a fully integrated post-acute care continuum offering rehabilitation and skilled nursing services in more than 45 locations covering four states. In addition, we provide special services including in-center and home dialysis, ventilator care, and care for those with Alzheimer’s. The Centers Health Care family offers Skilled Nursing, Urgent Care, Managed Care, Renal Dialysis Services, Clinical Laboratory Services, Adult Day Health Care, and Assisted Living services, as well as every level of Home Care. Centers is well known for our commitment to our employees, offering outstanding ongoing training and development, career advancement opportunities, competitive pay rates, generous compensation packages and more.
CentersHealthCare.com/careers
Equal Opportunity Employer –M/F/D/V
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