Renal Clinical Case Manager

Pentec Health; Crystal Bay (NV); Sur place; USD 65 000 - 79 000; Plein temps

Avantages offerts par ce poste

Medical

Dental

Vision

401k match

PTO

Paid holidays

Disability and life insurance

Employee assistance

Flexible spending or health savings

Résumé du poste

Pentec Health is seeking a Renal Clinical Case Manager located in the Pacific or Mountain time zones (OR, WA, ID, NV, AZ) to provide clinical expertise in IDPN/IPN therapies within our Revenue Cycle Management team. You will support therapy approvals, medical necessity documentation, and education for renal patients.

The role emphasizes autonomous decision-making, collaboration with care teams, and ongoing payer coordination.

Qualifications

• BS in Nutrition or related field
• Registered Dietitian or Licensed Nutritionist as required by state
• Experience in renal nutrition and CKD dialysis is preferred or required by state

Responsabilités

• Acts as clinical SME for Renal Dietitians, Nurses, Nephrologists and field staff in therapy management and reimbursement.
• Develops renal program to increase client base for IDPN/IPN and other PEN therapies; monitors patients on therapy.
• Coordinates with CSR/AE to obtain monthly labs and payor documents; reviews queue for active patients.
• Completes required forms and letters of medical necessity; escalates denials with payors as needed.
• Organizes CEU and Web-Ex CEU seminars; conducts educational sessions on IDPN/IPN therapies.

Connaissances

Autonomy

Decision-making

Communication

Formation

BS in Nutrition or related field

Registered Dietitian or Licensed Nutritionist as required by state

Outils

Microsoft Office

Description du poste

Our Renal Clinical Case Manager provides clinical expertise in management of IDPN and IPN therapies. This role manages internal aspects of therapy approval and authorization and assists with all clinical aspects needed for reimbursement within our Revenue Cycle Management team.

*FOR THIS ROLE YOU MUST BE LOCATED IN PACIFIC OR MOUNTAIN TIME ZONE: OREGON, WASHINGTON STATE, IDAHO, NEVADA AND ARIZONA

Essential Job Duties

• Acts as clinical Subject Matter Resource for Renal Dietitians, Nurses, Nephrologists, Account Executives and/or other field staff as well as Revenue Cycle Management staff. Participates in the Quality Management overview reviewing current and proposed processes and improvements.
• Assists in developing renal program to increase the client base for IDPN/IPN and other forms of Parenteral and Enteral Nutrition (PEN) and related services. Provides Clinical Assistance for all patients within the territory with routine evaluation and monitoring of patients requiring IDPN and IPN nutritional therapies.
• Responsible for coordinating with the CSR and AE to assure monthly labs and payor required documents are obtained for all active patients on therapy and assists AE by reviewing the queue
• Completes all necessary forms, documents and letters/statements of medical necessity as needed by renal centers, dialysis chains or payors. Escalates insurance denials as needed, in conjunction with Insurance Coordinators and/or Billers/Collectors, to payors to obtain approvals for coverage through telephone consultations or via written appeal letters.
• Is available to organize or assist with CEU and Web-Ex CEU seminars; conduct live displays and educational sessions regarding the use of IDPN/IPN and other nutritional therapies.
• *Other job duties and special projects as assigned.

Ideal Candidate Will Have

• BS degree in Nutrition or equivalent/related field; Must be a Registered Dietitian or Licensed Nutritionist as required by state, for at least two years. 1-2 years of practical experience in a full-service Dialysis facility.
• Experience in renal nutrition, especially in CKD 5 Dialysis, along with experience in dialysis related parenteral nutrition support therapies is required (IDPN required; IDPN/IPN preferred).
• Able to work autonomously and make independent decisions within generally accepted medical practices, regulations and guidelines.
• Intermediate computer skills with programs such as Microsoft Office Suite: Outlook, Word, Excel and Power Point.

Salary Range: $72,000.00 Annual

Pentec Health offers a comprehensive compensation and full benefits package. Actual pay will be based on several factors such as qualifications and skills for the role plus geographic location.

Benefits may include but are not limited to

• medical
• dental
• vision
• 401k match
• PTO
• paid holidays
• disability and life insurance
• employee assistance
• flexible spending or health savings account
• other additional voluntary benefits.