RN/LPN Case Manager Full-Time

Great opportunity for a Registered Nurse or Licensed Practical Nurse as a Case Manager at our organizations to handle HMO client authorizations and interacting with insurance company case managers

Duties include:

• Prepare, review & send electronic clinical documentation supporting medical necessity
• Monitor and evaluate calls & emails
• Review coordination of benefits
• Review weekly physical & occupational therapy notes and ensure rehab goals are being met
• Assess medical necessity criteria
• Maintain confidential records following HIPAA guidelines
• Track & appeal insurance denials
• Act as a liaison between nursing home & insurance
• Handle a high volume of phone calls and email correspondence

Case Manager Requirement

• Strong communication both written & verbal
• Strong computer skills
• Must have experience in the health insurance companies’ policies
• Medicare Advantage, Commercial Insurance & Medicaid Managed Care knowledge is required
• Must be proficient in Excel & Word,
• Must be a team player
• Salary: Based on experience
• Registered Nurse
• Licensed Practical Nurse