Managed Care Specialist

Managed Care Specialist (RN or LPN)We rely on and trust our Managed Care Specialist (RN or LPN) to provide centralized or field based case management for managed care and commercial insurance payers and residents. The right candidate for this role is a dedicated and compassionate team-player.Why Work For Us?Competitive PayExcellent health benefits packagesCareer advancement opportunitiesEducation reimbursement program of up to $7,500 per yearFlexible scheduling availableBenefits & Conditions:No waiting period for enrollmentThree health plan optionsDelta DentalVSP VisionFree Basic Life InsuranceDisability, Critical Illness, Accident & Legal Coverage401(k) Retirement PlanEmployee Assistance ProgramResponsibilities:Communicates care plan to insurance case managers with emphasis on strong discharge planningCommunicates, negotiates, and acts as liaison between Living Center/Agency and the insurance plan to ensure proper level of payment is assigned for services providedCommunicates insurance benefits to all levels of associatesUnderstands provisions of contracts and associated exclusionsWork closely with facility and external support staff for negotiation of services and ratesConsults on appeals, retro authorizations and collections issuesManage and maintain a live Spreadsheet to reflect changes in authorizations and continued stay reviews as they occurInitiate, confirm and update facility and external staff on status of AuthorizationsWork with insurance companies to ensure discharge disposition and documents are shared timelyPrep and submit insurance continued stay requests dailyNavigate the insurance, signing and return of NOMNC between insurance and facility staffObtain and Maintain copies of authorizations in member folders as well as in PCC documentsSubmit requests for cost out of high-cost drugs with Prior authorizations as well as concurrent reviewsQualifications:Licensed as a Registered Nurse (RN) or Licensed Practical Nurse (LPN)Minimum 2 years' experience with insurance providers preferredMinimum 2 years' experience in a long-term care setting preferredMust be capable of maintaining regular attendance