Regional RN Case Manager – Managed Care

Prestige Healthcare; Blountville (TN); On-site; USD 70,000 - 95,000; Full time

Benefits offered by this job

Affordable Medical, Dental & Vision

401k Retirement with Company Match

Tuition Reimbursement

Student Loan Repayment Program

Paid Vacation & Sick Time

Life Insurance

HSA & FSA

Unlimited Referral Bonuses

Job summary

Prestige Healthcare is seeking a Regional Case Manager RN to oversee a managed care caseload and coordinate with regional centers. The role emphasizes negotiation of rates, reviewing clinical records, and ensuring alignment with corporate and regional policies.

Travel across the region is mentioned as a requirement. The position focuses on maintaining relationships with managed care organizations, ensuring proper documentation, and collaborating with multiple departments to deliver contracted

Qualifications

• Registered Nurse preferred.
• Five years of experience with long-term care related managed care is expected (MDS background preferred).
• Ability to review contracts, negotiate rates, and coordinate with multiple internal teams.

Responsibilities

• Review all managed care contracts executed for facilities.
• Negotiate rates, levels, and one-time contracts with managed care organizations.
• Obtain authorization and re-authorization for new patients and maintain documentation.
• Train staff on pre-admission case management processes for regional contracts.
• Collaborate with Sales, Marketing, Business Office, Therapy, and Clinical teams to deliver contracted services.

Job description

Prestige Healthcare is seeking a Regional Case Manager RN to oversee a managed care caseload and coordinate with regional centers. The role emphasizes negotiation of rates, reviewing clinical records, and ensuring alignment with corporate and regional policies.

Travel across the region is mentioned as a requirement. The position focuses on maintaining relationships with managed care organizations, ensuring proper documentation, and collaborating with multiple departments to deliver contracted