Regional Case Manager: Insurance Authorization & Care

Eastern Healthcare Group; Clifton (NJ); On-site; USD 65,000 - 85,000; Full time

Job summary

A leading healthcare provider is seeking a Regional Case Manager to coordinate insurance authorization and case management functions across multiple facilities. The role requires a minimum of 2 years of relevant experience and a healthcare background. Strong communication and critical thinking skills are essential. This position plays a crucial role in ensuring compliance and optimizing reimbursements.

Qualifications

• Minimum of 2 years of experience in insurance authorization, utilization review, or case management.
• Current and active nursing license in good standing, if applicable.
• Familiarity with Medicare Part A/B and Managed Care rules.

Responsibilities

• Coordinate and obtain insurance authorizations for admissions and continued stays.
• Serve as the primary contact between facility case managers and insurance representatives.
• Review clinical documentation to support medical necessity.

Skills

Strong critical thinking and clinical review skills

Excellent written and verbal communication

High attention to detail and organizational accuracy

Proficiency in EMR systems and payer portals

Ability to work independently and collaboratively

Education

Graduate of an accredited program, preferably with a healthcare background

Job description

A leading healthcare provider is seeking a Regional Case Manager to coordinate insurance authorization and case management functions across multiple facilities. The role requires a minimum of 2 years of relevant experience and a healthcare background. Strong communication and critical thinking skills are essential. This position plays a crucial role in ensuring compliance and optimizing reimbursements.