Utilization Review Case Manager - Insurance Care Coordination

Resorts at Pooler; United States; On-site; USD 65,000 - 90,000; Full time

Benefits offered by this job

Restaurant d'entreprise

Indemnités de stage/alternance

Job summary

Resorts at Pooler is seeking a Clinical Case Manager - Utilization Review to coordinate insurance authorizations, care plans, and billing data.

You will interface with admissions, nursing, therapy, social work, and the billing department to ensure accurate documentation and timely reimbursements.

The role emphasizes organized records, proactive communication with payers, and rigorous tracking of authorizations and reviews to support residents' care and the facility's finances.

Qualifications

• Experience managing schedules and data across multiple cases.
• Proficient with EMR and spreadsheet tools.
• Strong communication with payers and care teams.
• Background in long-term care or skilled nursing.

Responsibilities

• Obtain and track initial and ongoing authorizations with payers.
• Collaborate with care team to align plans with insurance requirements.
• Verify coverage and resolve denials with the billing office.
• Maintain organized digital files and logs for authorizations and notes.

Skills

Org skills

Excel/Sheets

Communication

Clinical knowledge

Tools

EMR systems

Microsoft Excel

Job description

Resorts at Pooler is seeking a Clinical Case Manager - Utilization Review to coordinate insurance authorizations, care plans, and billing data.

You will interface with admissions, nursing, therapy, social work, and the billing department to ensure accurate documentation and timely reimbursements.

The role emphasizes organized records, proactive communication with payers, and rigorous tracking of authorizations and reviews to support residents' care and the facility's finances.