Utilization Management/Case Manager

Accolade-Health-Care; Champaign (IL); Hybrid; USD 75,000 - 90,000; Full time

Benefits offered by this job

Medical, Dental, Vision

401k with company match

Paid Leave

Daily Pay partner

Job summary

Accolade Healthcare is seeking a Utilization Management/Case Manager to coordinate care for SNF patients with emphasis on insurance authorizations, case management, and discharge planning. This role ensures services are appropriately authorized and efficiently managed to optimize patient and financial outcomes.

The position offers a competitive salary and benefits; on-site or hybrid work environment depending on facility needs, with opportunities to collaborate across disciplines.

Qualifications

• RN license or equivalent clinical credential.
• Minimum 2 years of case management experience.
• Knowledge of insurance authorization processes.
• Familiarity with CMS guidelines and appeals.
• Ability to manage a high-volume caseload.
• Excellent communication and negotiation skills.

Responsibilities

• Coordinate care for SNF patients with timely authorizations.
• Collaborate with care teams to ensure seamless transitions.
• Obtain and manage insurance authorizations for SNF care.
• Negotiate with payors when non-contracted.
• Review denials and assist with appeals.
• Maintain accurate documentation per standards.
• On-site or hybrid work arrangement.

Skills

Case management

Insurance authorizations

Discharge planning

CMS guidelines

Medicare/Medicaid

EHR proficiency

No-Fault contracts

Negotiation skills

Communication

Interdisciplinary teamwork

Education

RN License

Tools

Case management software

EHR software

Job description

Accolade Healthcare

Utilization Management/Case Manager

About Us

At Accolade Healthcare, we put an emphasis on the satisfaction of our team members, understanding that a foundation built on quality patient care starts with the people providing the care. Our goal is to care for our staff with respect, empathy, and appreciation. Providing our professional staff with safe and efficient equipment to complete their mission is our priority. Accolade is committed to never being satisfied with industry norms and standards - instead, always searching for creative methods to equip our team with the tools necessary to achieve success.

Job Summary

As a Utilization Management/Case Manager at Accolade Healthcare, you will be responsible for coordinating the continuum of care for patients, with a strong focus on insurance authorizations, case management, and discharge planning. This role is vital to ensure that services are covered, appropriately authorized, and effectively managed to achieve optimal patient and financial outcomes.

Pay: $75,000-$90,000 annually

Benefits

• Medical, Dental, Vision and additional other voluntary benefits
• 401k with company match
• Generous Paid Leave Policy
• Daily Pay partner

Responsibilities

As a Utilization Management/Case Manager, your responsibilities include:

• Coordinate and manage care for a caseload of SNF patients, ensuring timely authorizations and continued stay approvals.
• Collaborate with interdisciplinary care teams, including physicians, therapists, social workers, and payors, to promote seamless transitions and quality care.
• Obtain and manage insurance authorizations for inpatient SNF care, including commercial plans, Medicare Advantage, Medicaid, Workman's Compensation, No-Fault, and Single Case Agreements (SCA).
• Negotiate reimbursement rates for non-contracted payors when necessary.
• Review and respond to denials and discrepancies in authorizations; prepare appeal documentation and participate in QIO or health plan-level appeals as needed.
• Identify patient care needs, assess insurance limitations, and work with the healthcare team to develop appropriate care plans.
• Advocate for patient access to appropriate services while maintaining compliance with insurance guidelines.
• Maintain accurate and up-to-date documentation in accordance with facility, insurance, and regulatory standards.

Skills and Qualifications

To excel as a Utilization Management/Case Manager, you will need:

• Licensed Registered Nurse (RN) or equivalent clinical credential preferred.
• Minimum 2 years of case management experience, preferably in a SNF, hospital, or managed care setting.
• Strong knowledge of insurance authorization processes, managed care, and appeal strategies.
• Experience with Single Case Agreements, Workman's Comp, and No-Fault contracts.
• Excellent communication, negotiation, and interdisciplinary collaboration skills.
• Proficient in electronic health records and case management software.
• Familiarity with CMS guidelines, QIO processes, and discharge planning protocols.
• Ability to manage a high-volume caseload with a proactive and organized approach.
• Knowledge of Medicare and Medicaid regulations specific to SNFs.

On-site or hybrid work environment depending on facility needs.

Fast-paced, patient-centered setting with frequent interaction with healthcare professionals and insurance representatives.