Intake Operations Lead – LTACH Admissions & Referrals

Prime Healthcare; Rosemont (IL); On-site; USD 84,000 - 113,000; Full time

Job summary

Prime Healthcare is seeking an experienced LTACH Case Manager for Holy Family Medical Center in Des Plaines, IL. You will lead LTACH admissions, perform screenings, and coordinate transitions for patients requiring higher levels of care.

The role requires 2+ years in hospital settings, knowledge of Utilization Review and InterQual/Milliman criteria, and collaboration with physicians, payors, and care teams to secure timely authorizations and patient transfers.

Qualifications

• Medical, dental, PA, or nursing graduate required.
• Two years of hospital setting experience.
• Experience in Utilization Review/Management preferred.
• Knowledge of InterQual and Milliman criteria preferred.
• Healthcare management experience preferred.
• Knowledge of reimbursement and managed care structures preferred.

Responsibilities

• Serve as the operational lead for LTACH admissions and referral management.
• Screens and conducts clinical reviews of patients for LTACH appropriateness.
• Identifies in-system patients who may benefit from LTACH level of care and coordinates follow-up for ongoing management.
• Collaborates with physicians, case managers, hospital leadership, and clinical liaisons to coordinate patient transitions to LTACH.
• Works with managed care payors to obtain prior authorization and facilitate timely transfers when appropriate.
• Completes intake processes including information about hospital services and programs; coordinates tours, referrals, and prior authorizations.
• Maintains updated referral logs and accurate registration, admission, and discharge data; supports data statistics for the department.
• Performs other duties as assigned.

Skills

Utilization Review/Management

InterQual criteria

Milliman criteria

Healthcare management

Education

Medical Graduate

Dental Graduate

PA

Nursing Graduate

Tools

InterQual

Milliman

Job description

Prime Healthcare is seeking an experienced LTACH Case Manager for Holy Family Medical Center in Des Plaines, IL. You will lead LTACH admissions, perform screenings, and coordinate transitions for patients requiring higher levels of care.

The role requires 2+ years in hospital settings, knowledge of Utilization Review and InterQual/Milliman criteria, and collaboration with physicians, payors, and care teams to secure timely authorizations and patient transfers.