Renal Clinical Case Manager

Pentec Health; Idaho; On-site; USD 65,000 - 79,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

401k match

Paid time off

Job summary

Pentec Health is seeking a Renal Clinical Case Manager in Idaho to provide clinical expertise in IDPN and IPN therapies within our Revenue Cycle Management team. Coordinate with renal dietitians, nurses, nephrologists, account executives, and payors to obtain approvals and support reimbursement processes.

The ideal candidate holds a BS in Nutrition and is a Registered Dietitian or Licensed Nutritionist, with 2+ years in dialysis settings and strong Office skills.

Qualifications

• BS degree in Nutrition or related field, required.
• Registered Dietitian or Licensed Nutritionist per state requirements, at least 2 years in a renal setting.
• Experience in renal nutrition and dialysis-related PN support.
• Able to work autonomously with basic computer skills (Outlook, Word, Excel, PPT).

Responsibilities

• Act as clinical SME for Renal Dietitians, Nurses, Nephrologists, and Revenue Cycle staff.
• Develop renal programs to expand IDPN/IPN services and client base.
• Coordinate with CSR/AE to obtain labs and payer documents for all active patients.
• Prepare medical necessity letters and appeals to payors with billing staff.
• Organize CEU and Web-Ex CEU sessions and educational events.

Skills

Autonomy

Renal nutrition

Communication

Office suite

Education

BS in Nutrition or related field

Registered Dietitian or Licensed Nutritionist

Tools

Microsoft Office

Excel

PowerPoint

Job description

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, and other additional voluntary benefits.