Managed Care Specialist (RN/LPN)

We rely on and trust our Managed Care Specialist (RN or LPN) to provide centralized or field based case management for managed care and commercial insurance payers and residents. The right candidate for this role is a dedicated and compassionate team-player.

Why Work For Us?

• Competitive Pay
• Excellent health benefits packages
• Career advancement opportunities
• Education reimbursement program of up to $7,500 per year
• Flexible scheduling available

Benefits & Conditions:

• No waiting period for enrollment
• Three health plan options
• Delta Dental
• VSP Vision
• Free Basic Life Insurance
• Disability, Critical Illness, Accident & Legal Coverage
• 401(k) Retirement Plan
• Employee Assistance Program

Responsibilities:

• Communicates care plan to insurance case managers with emphasis on strong discharge planning
• Communicates, negotiates, and acts as liaison between Living Center/ Agency and the insurance plan to ensure proper level of payment is assigned for services provided
• Communicates insurance benefits to all levels of associates
• Understands provisions of contracts and associated exclusions
  
• Work closely with facility and external support staff for negotiation of services and rates
  
• Consults on appeals, retro authorizations and collections issues
  
• Manage and maintain a live Spreadsheet to reflect changes in authorizations and continued stay reviews as they occur
  
• Initiate, confirm and update facility and external staff on status of Authorizations
  
• Work with insurance companies to ensure discharge disposition and documents are shared timely
  
• Prep and submit insurance continued stay requests daily
  
• Navigate the insurance, signing and return of NOMNC between insurance and facility staff
  
• Obtain and Maintain copies of authorizations in member folders as well as in PCC documents
  
• Submit requests for cost out of high-cost drugs with Prior authorizations as well as concurrent reviews

Qualifications:

• Licensed as a Registered Nurse (RN) or Licensed Practical Nurse (LPN)
  
• Minimum 2 years' experience with insurance providers preferred
  
• Minimum 2 years' experience in a long-term care setting preferred
  
• Must be capable of maintaining regular attendance

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