Clinical Case Manager

Position: Clinical Case Manager

We are seeking a compassionate, detail-oriented Case Manager who is passionate about patient care and advocating for the skilled services patients truly need. The ideal candidate is someone who can effectively review clinical documentation, collaborate with interdisciplinary teams, and work closely with insurance companies to secure appropriate coverage and continued rehab stays for patients. A strong understanding of managed care, levels of care, PDPM, and reimbursement guidelines is important to effectively advocate for patients and support the appropriate level of care.

Compensation:

Salary: 60-65k based on experience

Benefits package:

1. Medical, Dental, Vision insurance
2. 401(k) Retirement plan
3. Paid Time Off ( PTO ) - start earning from day one!
4. Supplemental insurance options
5. Ask about our pay in lieu of benefits option at your interview! Earn additional pay per hour!
6. Access to ongoing training and professional development opportunities
7. Discounts on premium amenities and services
8. On-Demand Pay options

Location: Remote

Key Responsibilities:

• Review nursing and therapy documentation to ensure accurate clinical support for skilled rehab services
• Advocate for patients by communicating with insurance companies regarding authorizations, continued stays, and level of care needs
• Work closely with therapy, nursing, admissions, and families to coordinate patient care plans
• Identify and address gaps in documentation to support medical necessity
• Monitor insurance updates, authorization deadlines, and payer requirements
• Maintain accurate records with strong attention to detail
• Participate in interdisciplinary team meetings and discharge planning discussions
• Help ensure patients receive the appropriate time and services needed for successful rehabilitation outcomes

Qualifications:

• Must be an MDS-certified professional with relevant MDS experience OR a current licensed PT, OT, or ST (PTA/COTA accepted)
• Previous experience working in a Skilled Nursing Facility (SNF) required.
• Experience with HMO/Managed Care SNF authorizations strongly preferred.
• Strong understanding of PDPM, HIPPS codes, and Medicare reimbursement guidelines
• Strong ability to review and interpret nursing and therapy documentation and identify information that supports skilled care and continued stay.
• Excellent attention to detail with the ability to manage multiple patients, deadlines, and authorization requirements.
• Strong communication and advocacy skills, particularly when communicating with insurance companies regarding patient coverage.
• Experience with PointClickCare (PCC) and NetHealth preferred.

What We’re Looking For

We want someone who:

• Truly cares about patients and their rehab success
• Knows how to tell the patient’s clinical story through documentation
• I s persistent and confident when working with insurance companies
• Can recognize important clinical details that support continued skilled care
• Thrives in a fast-paced healthcare environment while staying organized and compassionate

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