Regional Insurance Authorization Leader

EHG; Clifton (NJ); On-site; USD 65,000 - 90,000; Full time

Job summary

Eastern Health Group is seeking a Regional Case Manager to coordinate insurance authorizations and case management across our network of skilled nursing and long-term care facilities. From our corporate office, you will liaise with facility teams, payers, and external partners to optimize reimbursement, ensure CMS and payer compliance, and prevent denials.

The ideal candidate has at least 2 years in insurance authorization or case management, a nursing license if applicable, and strong EMR

Qualifications

• Graduate of an accredited program; healthcare background preferred.
• Active nursing license in good standing, if applicable.
• Minimum 2 years in insurance authorization, utilization review, or case management in skilled/long-term care or managed care.
• Knowledge of Medicare Part A/B, Managed Care, and Virginia Medicaid rules and processes.

Responsibilities

• Coordinate and obtain insurance authorizations for admissions, continued stays, and skilled service requests.
• Serve as primary liaison between facility case managers, billing teams, and insurance representatives.
• Review clinical documentation to support medical necessity and payer requirements.
• Track and monitor authorization requests, approvals, and expirations to prevent lapses in coverage.
• Maintain records of authorizations, payer communications, and denials; ensure timely updates per payer requirements.
• Collaborate with MDS Coordinators, DONs, Administrators, BOMs, and therapists to ensure clinical/financial alignment.
• Analyze payer denials and delays; provide feedback and training to staff as needed.
• Support centralized case management workflow and process improvements.
• Uphold HIPAA, CMS, and state regulatory requirements in all documentation.

Skills

Critical thinking

Communication

Attention to detail

Independent and collaborative work

Organizational skills

Education

Healthcare background

Tools

EMR systems

Payer portals

Job description

Eastern Health Group is seeking a Regional Case Manager to coordinate insurance authorizations and case management across our network of skilled nursing and long-term care facilities. From our corporate office, you will liaise with facility teams, payers, and external partners to optimize reimbursement, ensure CMS and payer compliance, and prevent denials.

The ideal candidate has at least 2 years in insurance authorization or case management, a nursing license if applicable, and strong EMR