Utilization Management/Case Manager

Accolade Health Care LLC.; Champaign (IL); On-site; USD 75,000 - 90,000; Full time

Benefits offered by this job

Medical, Dental, Vision

401k with company match

Paid Leave Policy

Daily Pay partner

Job summary

Accolade Healthcare in Champaign, IL seeks a Utilization Management/Case Manager to coordinate care, secure insurance authorizations, and plan discharges for SNF patients. You will work with physicians, therapists, social workers, and payors to ensure timely approvals and smooth transitions while maintaining regulatory compliance.

The role requires an RN or equivalent credential and 2+ years in case management, with strong knowledge of CMS guidelines and EHR systems.

Qualifications

• Licensed RN or equivalent clinical credential preferred.
• Minimum 2 years of case management experience, preferably in SNF, hospital, or managed care.
• Strong knowledge of insurance authorization processes and appeal strategies.
• Experience with Single Case Agreements, Workman’s Comp, and No-Fault contracts.

Responsibilities

• Coordinate and manage care for a caseload of SNF patients with timely authorizations and ongoing stay approvals.
• Collaborate with interdisciplinary teams to promote seamless transitions and quality care.
• Obtain and manage insurance authorizations for inpatient SNF care across commercial, Medicare Advantage, Medicaid, WC, No-Fault, and SCA.
• Negotiate reimbursement rates for non-contracted payors when necessary.
• Review denials and discrepancies; prepare appeals and participate in health plan appeals as needed.
• Identify patient care needs and develop appropriate care plans with the healthcare team.
• Advocate for patient access to services while ensuring compliance with insurance guidelines.
• Maintain accurate documentation per facility, insurance, and regulatory standards.

Skills

RN license

Case management

Insurance authorization

CMS guidelines

EMR/EHR

Communication

Collaboration

Negotiation

Education

RN or equivalent

Tools

EMR/EHR

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.