Regional Insurance Case Manager - Long-Term Care

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

Job summary

Eastern Health Group seeks a Regional Case Manager to coordinate insurance authorizations and case management across our skilled nursing network. You will liaise between facility teams, payers, and external partners to optimize reimbursement and ensure CMS/compliance.

Ideal candidates have an active RN license and at least 2 years in insurance authorization or case management within skilled or managed care settings, with strong communication and EMR proficiency.

Qualifications

• RN license active in good standing.
• Healthcare background preferred.
• Minimum 2 years in insurance authorization or case management in skilled/long-term care or managed care.

Responsibilities

• Coordinate and obtain insurance authorizations for admissions and continued stays.
• Serve as primary contact between facility case managers, billing, and payers.
• Review clinical docs to support medical necessity and payer requirements.
• Track authorizations, approvals and expirations to prevent lapses.
• Maintain detailed records of authorizations, payer communications and denials.

Skills

Critical thinking

Clinical review

Written communication

Verbal communication

Attention to detail

EMR systems

Payer portals

Independent work

Team collaboration

Education

RN license (active)

Tools

EMR systems

Payer portals

Job description

Eastern Health Group seeks a Regional Case Manager to coordinate insurance authorizations and case management across our skilled nursing network. You will liaise between facility teams, payers, and external partners to optimize reimbursement and ensure CMS/compliance.

Ideal candidates have an active RN license and at least 2 years in insurance authorization or case management within skilled or managed care settings, with strong communication and EMR proficiency.