Managed Care Specialist (RN or LPN)

Brickyard Healthcare; Meridian Hills (IN); On-site; USD 37,000 - 42,000; Full time

Job summary

A leading healthcare provider seeks a Managed Care Specialist (RN or LPN) to deliver effective case management in a centralized or field setting. This role emphasizes communication with insurance, negotiation of services, and ensuring residents receive necessary care while managing authorizations. Join a compassionate team offering competitive pay and substantial benefits, including flexible scheduling and educational reimbursement up to $7,500.

Benefits

Competitive Pay

Excellent health benefits packages

Career advancement opportunities

Education reimbursement program

Flexible scheduling

401(k) Retirement Plan

Qualifications

• 2 years’ experience with insurance providers preferred.
• 2 years' experience in a long-term care setting preferred.
• Regular attendance is a must.

Responsibilities

• Communicates care plans to insurance case managers.
• Acts as liaison between Living Center/Agency and insurance.
• Manages authorization requests for insurance.

Skills

Communication

Negotiation

Case Management

Education

Registered Nurse (RN) or Licensed Practical Nurse (LPN)

Job description

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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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