Managed Care Coordinator

Aperion Care; Lincolnwood, Northern (IL, KY); On-site; USD 55,000 - 75,000; Full time

Job summary

Aperion Care, Inc. in Lincolnwood, Illinois is looking for a Managed Care Case Management professional. The role involves reviewing referral requests and verifying insurance benefits for skilled care stays. Candidates should have experience in skilled nursing facilities and understanding of Medicare and insurance processes.

This position requires strong organizational and problem-solving skills, with a preference for candidates who have worked with MCO insurance systems. A college degree is preferred.

Qualifications

• Experience working in a skilled nursing facility.
• Understanding of claims under Commercial and Medicare Advantage plans.
• 2 years of MCO insurance experience preferred.

Responsibilities

• Liaison between marketing, admissions, and MCO case management.
• Verification of referrals before handing off to case managers.
• Maintain and close out Managed Care Referral Log.

Skills

Organizational skills

Problem-solving skills

MCO insurance experience

Education

College Degree

Job description

SUMMARY

In support of Managed Care Case Management perform the duties of triaging daily referral requests for all Commercial, MMAI, and Medicare Advantage plans for skilled care stays for all facilities. Insures all required information is provided before handing off to Case Managers. Performs insurance verifications for commercial plans as well as plan benefits verifications for all referrals.

ESSENTIAL DUTIES AND RESPONSIBILITIES

• Primary liaison between marketing liaisons, facilities admissions and MCO Case Management for new referrals and readmissions.
• Communicates and maintains effective working relationships with marketing teams, facility contacts, and case management team as relates to referral process.
• Performs review of referral requests for completeness of information and determines when ready to move to a case manager for preauthorization.
• Perform benefit verifications on all referrals adhering to appropriate processes.
• Able to hold facilities accountable to adhere to the process for referrals to case management of MCO cases.
• Maintain / Close out Manage Care Referral Log.
• Assistant to Case Management Consultant – Obtaining Auth, communication with communities, and communication with insurance companies.

QUALIFICATIONS

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements below are representative of the knowledge, skill, and/or ability required.

• College Degree is Preferred
• Experience working in a skilled nursing facility
• Understanding of how claims are paid under Commercial and Medicare Advantage plans for skilled services.
• 2 years working with MCO insurance experience is preferred
• Self-Starter and results orientated personality.
• Strong organizational, planning and problem-solving skills.
• Able to work multiple tasks before a task is completed.
• Understanding of the differences in types of insurance that is taken at a skilled nursing facility.
• Working understanding of Medicare rules as it is applied to a skilled nursing facility.

PHYSICAL DEMANDS

The physical demands are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Must be able to move intermittently throughout the workday.
• Must be able to speak and write the English language in an understandable manner.
• Must be able to push, pull, move, and/or lift a minimum of 25 pounds to a minimum height of 5 feet and be able to push, pull, move, and/or carry such weight a minimum of 50 feet.
• May be necessary to assist in the evacuation of residents during emergency situations.