Care Manager- RN or LSW

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

The nation's leading administrator of long term care insurance services is looking for YOU. This is your opportunity to join a company with a culture that promotes respect for people, integrity, learning and initiative.

WE ARE THE KIND OF EMPLOYER YOU DESERVE.LTCG is a leading provider of business process outsourcing for the insurance industry, managing over 1.3 million long-term care policies for the nation's largest insurers. We also provide clients with unique risk management insight built upon our proprietary long term care databases.

This position is responsible for gathering and reviewing requirements for the purpose of determining initial and ongoing claimant and provider eligibility.

Responsibilities

• Assess claimant eligibility by reviewing medical records from all current providers and conducting phone assessments with the claimant or legal representative. In the event of noted inconsistencies in the claimant eligibility, coordinate a benefit eligibility assessment in order to make a final determination.
• In conjunction with plan language upon initial assessment and ongoing recertification, determine legitimacy and eligibility of service providers by requesting and reviewing provider licensing credentials, state-specific regulations, internet searches and phone assessments with the servicing provider.
• Effectively communicate, verbal and written, all aspects of the claim benefit determination process.
• Assist claimants with modifications to their current care plan, including changes in care needs as well as changes in provider.
• Monitor daily, weekly and monthly reports to ensure claims are handled timely and appropriately.
• Attend case conferences, internally and with the client, to present claims recommendations.
• Meet quality and production metrics as established and communicated by the department.
• Reviews Care Coordinator decision recommendations on tax qualified policies.
• Other duties as assigned.