Regional Case Manager - RN or LPN
5 days ago
Lansing
Job DescriptionRegional Case Manager (RCM) Registered Nurse (RN) Do You Currently Work in Long-term Care or Hospital Case Management and Ready for a Regional Role? Are you ready to reset your case management career with a dynamic and growing healthcare company? If you’re ready for the challenge, YOU could be the right fit for this position! Prestige Healthcare is a leading provider of skilled nursing and rehabilitation services. We are seeking a dynamic remote Regional Case Manager who has a strong work ethic, exceptional organization skills, pays attention to detail, and enjoys working in a fast-paced environment to join our team! Can You Answer Yes to the Following Questions? If So, Apply Today! • Are you a Registered Nurse with exceptional Case Management experience in long-term care?, • Do you consider yourself an expert in Medicaid, Medicare, and MDS?, • Competitive Salary, • Affordable Medical, Dental, and Vision Benefits for You & Your Family, • Employee Benefits Concierge – to Guide You in Maximizing Your Benefits, • Three Pet Insurance Options for your Furry Friend, • Tuition Reimbursement, • Student Loan Repayment Program, • Company Paid Life Insurance, • Paid Vacation Days with Rollover Option and Sick Time, • 401k Retirement with Company Match, • Health Savings Account (HSA) and Flexible Spending Account (FSA), • Registered Nurse preferred.Experience:, • Five years of experience with long-term care related managed care. A background in MDS is preferred.Job Functions:, • Review all managed care contracts executed for their facilities., • Understand and communicate the needs of the regional and center staff to the Director of Managed Care to assure consistency in direction and execution of managed care., • Establish relationships with managed care organization’s Case Managers, specific to region., • Review clinical record, identify and negotiate higher levels and exclusions, where applicable., • Negotiate all rates, levels and one-time contracts for defined health centers managed care patients., • Obtain authorization, re-authorization and notifications for all new managed care patients for health center., • Complete all required documentation associated with rates, levels of care, cuts and exhausts as required by managed care organization., • Complete and maintain Case Manager Log on a daily basis., • Communicate with centers the needed documentation for continued stay and patient cuts., • Participate with facilities weekly (telephonically or center visit) to review managed care patients., • Participate in monthly triple check meetings for final review of UB statements and billing of negotiated exclusions., • Train facility staff on pre-admission case management process specific to their regional contracts., • Work collaboratively with Sales and Marketing, Business Office, Therapy, and Clinical team to provide appropriate services needed within the definition of the managed care contract., • Assist with any audits by the managed care organizations in conjunction with Medical Review., • Performs other duties as assigned. Knowledge/Skills/Abilities:, • Ability to use personal computer and application software such as Excel and Microsoft Word., • Functional speech, vision and hearing., • Ability to communicate professionally and effectively with referral sources at all levels of the organization both orally and in written form., • Strong organizational skills. Ability to organize and prioritize., • Able to work independently, self-motivated and goal oriented. Demonstrates self-confidence.