Care Manager: Long-Term Care Eligibility & Claims

illumifin Corporation; Minnesota; On-site; USD 55,000 - 75,000; Full time

Job summary

LTCG in Minnesota is seeking a Claims Eligibility Analyst to review medical records and conduct phone assessments to determine initial and ongoing eligibility for claimant benefits. The role involves evaluating provider eligibility using licensing data and state regulations, and communicating findings to clients and internal teams.

Successful candidates will participate in case conferences, adhere to quality metrics, and support modifications to care plans as needed.

Qualifications

• Experience reviewing medical records for eligibility.
• Familiarity with plan language and state regulations.
• Strong communication and attention to detail.

Responsibilities

• Assess claimant eligibility by reviewing medical records and conducting phone assessments.
• Coordinate benefit eligibility assessments when inconsistencies are found.
• Determine provider eligibility by reviewing licensing credentials and state regulations.
• Communicate all aspects of the claim determination process in writing and verbally.
• Attend case conferences with clients to present recommendations.
• Meet quality and production metrics established for the department.
• Other duties as assigned.

Skills

Medical records review

Phone assessments

Eligibility determinations

Communication skills

Tools

Licensing databases

Job description

LTCG in Minnesota is seeking a Claims Eligibility Analyst to review medical records and conduct phone assessments to determine initial and ongoing eligibility for claimant benefits. The role involves evaluating provider eligibility using licensing data and state regulations, and communicating findings to clients and internal teams.

Successful candidates will participate in case conferences, adhere to quality metrics, and support modifications to care plans as needed.