Care Continuum Navigator: Utilization & Case Mgmt

Accolade-Health-Care; Champaign (IL); Hybrid; USD 75,000 - 90,000; Full time

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

401k with company match

Paid leave policy

Daily Pay

Job summary

Accolade Healthcare is seeking a Utilization Management/Case Manager to coordinate the continuum of care with a strong focus on authorizations, case management, and discharge planning. You will ensure services are appropriately authorized and managed to optimize patient and financial outcomes.

You will work in a fast-paced, patient-centered environment with collaboration across physicians, therapists, social workers, and payors, in a hybrid or on-site setting depending on facility needs.

Qualifications

• Licensed RN or equivalent clinical credential required or preferred.
• Minimum 2 years of case management experience, preferably in SNF, hospital, or managed care.
• Strong knowledge of insurance authorization processes, managed care, and appeal strategies.

Responsibilities

• Coordinate and manage care for SNF patient caseload with timely authorizations and stays.
• Collaborate with interdisciplinary teams to promote seamless transitions and quality care.
• Obtain and manage insurance authorizations for inpatient SNF care (commercial, Medicare Advantage, Medicaid, WC, No-Fault, SCA).
• Negotiate reimbursement rates for non-contracted payors when needed.
• Review denials and discrepancies; prepare appeal documentation and participate in appeals as needed.
• Identify patient needs, assess insurance limitations, and develop appropriate care plans.
• Advocate for patient access while complying with insurance guidelines.
• Maintain accurate documentation per standards.

Skills

RN license

Case management

Interdisciplinary collaboration

Negotiation

EHR proficiency

Education

RN license or equivalent credential

Tools

EHR software

Case management software

Job description

Accolade Healthcare is seeking a Utilization Management/Case Manager to coordinate the continuum of care with a strong focus on authorizations, case management, and discharge planning. You will ensure services are appropriately authorized and managed to optimize patient and financial outcomes.

You will work in a fast-paced, patient-centered environment with collaboration across physicians, therapists, social workers, and payors, in a hybrid or on-site setting depending on facility needs.