Managed Care Specialist (RN or LPN)

Brickyard Healthcare; Fishers (IN); On-site; USD 53,000 - 89,000; Full time

Job summary

Brickyard Healthcare is seeking a Managed Care Specialist (RN or LPN) to provide essential case management for managed care and commercial insurance. The ideal candidate will ensure effective negotiation and communication between stakeholders while maintaining compliance with insurance guidelines. This role offers competitive pay, excellent benefits, and opportunities for career advancement.

Benefits

Education reimbursement program up to $7,500 per year

Flexible scheduling available

Competitive Pay

Excellent health benefits packages

Qualifications

• Minimum 2 years’ experience with insurance providers preferred.
• Experience in a long-term care setting preferred.
• Ability to maintain regular attendance is essential.

Responsibilities

• Provide centralized or field-based case management for managed care.
• Act as liaison between the Living Center and insurance plans.
• Manage authorization requests and maintain documentation.

Skills

Communication

Negotiation

Teamwork

Education

Licensed as a Registered Nurse (RN)

Licensed Practical Nurse (LPN)

Job description

Join to apply for the Managed Care Specialist (RN or LPN) role at Brickyard Healthcare

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Join to apply for the Managed Care Specialist (RN or LPN) role at Brickyard Healthcare

We rely on and trust our Managed Care Specialist (RN or LPN) to provide centralized or field based case management for managed care and commercial insurance payers and residents. The right candidate for this role is a dedicated and compassionate team-player.

Why Work For Us?

• Competitive Pay
• Excellent health benefits packages
• Career advancement opportunities
• Education reimbursement program of up to $7,500 per year
• Flexible scheduling available
  

Benefits & Conditions

• No waiting period for enrollment
• Three health plan options
• Delta Dental
• VSP Vision
• Free Basic Life Insurance
• Disability, Critical Illness, Accident & Legal Coverage
• 401(k) Retirement Plan
• Employee Assistance Program
  
  

Responsibilities

• Communicates care plan to insurance case managers with emphasis on strong discharge planning
• Communicates, negotiates, and acts as liaison between Living Center/ Agency and the insurance plan to ensure proper level of payment is assigned for services provided
• Communicates insurance benefits to all levels of associates
• Understands provisions of contracts and associated exclusions
• Work closely with facility and external support staff for negotiation of services and rates
• Consults on appeals, retro authorizations and collections issues
• Manage and maintain a live Spreadsheet to reflect changes in authorizations and continued stay reviews as they occur
• Initiate, confirm and update facility and external staff on status of Authorizations
• Work with insurance companies to ensure discharge disposition and documents are shared timely
• Prep and submit insurance continued stay requests daily
• Navigate the insurance, signing and return of NOMNC between insurance and facility staff
• Obtain and Maintain copies of authorizations in member folders as well as in PCC documents
• Submit requests for cost out of high-cost drugs with Prior authorizations as well as concurrent reviews
  
  

Qualifications

• Licensed as a Registered Nurse (RN) or Licensed Practical Nurse (LPN)
• Minimum 2 years’ experience with insurance providers preferred
• Minimum 2 years' experience in a long-term care setting preferred
• Must be capable of maintaining regular attendance
  
  

#BYHCIND

Seniority level

• Seniority level

  Entry level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Health Care Provider

• Industries

  Hospitals and Health Care

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