Case Manager

Job Description

Job Description

Overview

Responsibilities

• Receives/responds to incoming calls from referral sources/potential clients and exchanges information to identify the clients' needs and consults with Director of Clinical Management to determine the Company's ability to meet them.
• Completes all viable referrals by setting up and carrying out pre-screening assessments, completion of pre-screening reports, and preparation of case proposals and other related pre-admission paperwork (i.e., obtains authorization for payment, coordinates availability of an appropriate treatment team).
• Oversees, directs and supervises field staff assigned in assisting with pre-screening process.
• Accesses national/state/company account information, including the account names and terms of contracts or other past payer agreements, as appropriate.
• Consults with third party representatives regarding client benefit coverage, client financial responsibility, company service authorization and specific reimbursement procedures. Presents company’s services, interprets potential reimbursement options and negotiates reimbursement levels with third party payer.
• Contacts referral sources to advise them of case acceptance and provides information on the clinical team responsible for client's case.
• Develops/maintains a working knowledge of all services/resources provided by the Company and services available within the community. Assists in identifying alternative community service sources when company solutions are not appropriate or available.
• Maintains relationships with standard referral sources and payer case managers. Contacts identified referral sources and seeks referrals as appropriate. Records outcome of calls and keeps the SAR informed.
• Monitors/tracks referral sources' satisfaction levels, tracks/reports on conversion ratios and provides summary reports to management at requested intervals.
• Implements/maintains, with the up line management, operational processes to ensure compliance with Company policies, requirements and regulatory mandates.
• Adheres to and participates in Company’s mandatory HIPAA privacy program/practices and Business Ethics and Compliance programs.
• Participates in quarterly growth planning meetings/activities including discussions around staffing and recruitment needs.
• Participates in special projects and performs other duties as assigned.

Qualifications

• Bachelor's degree in a human services field or nursing field.
• Valid driver's license.
• Must have two years of experience with case management or related discipline
• Must be able to communicate both verbally and in writing.