Regional Managed Care Case Manager for SNF/LTC

Job Description

Job Description

Virtue Clinical Solutions is actively seeking an experienced Regional Managed Care Manager to oversee Managed Care programs for skilled nursing facilities. This position is suited for a healthcare professional with a robust background in skilled nursing care management and a keen ability to lead remote teams.

Experience Requirements:

• Required : Minimum of 1-3 years direct experience in skilled nursing facilities, with specific skills in obtaining Managed Care authorizations and appeals 
• Preferred : Over 5 years of experience, including supervisory roles overseeing team members and managing complex healthcare operations, preferably within managed care environments.

 

Responsibilities:

• Manage and track authorizations for HMO patients across multiple skilled nursing facilities.
• Supervise a team of case managers, and managed care coordinators ensuring seamless communication between Admissions, Social Work, Rehab, and Billing departments.
• Lead critical care committees and enhance overall service delivery and patient care.
• Coordinate with insurance case managers to discuss patient care plans, progress, and discharge plans, and advocate for patient care.
• Compile appeal packages for denied services or coverage.
• Promote ongoing professional development and ensure staff competencies align with the highest standards of care.

 

Qualifications:

• In-depth knowledge of Medicare, Medicaid, and Commercial Insurance guidelines, including specific programs like HARP, AARP, Obamacare, No-Fault, and Workers Comp.
• Experience within skilled nursing facility settings.
• Strong leadership capabilities with demonstrated skills in mentoring and developing remote teams.
• Proficient in Microsoft Excel and Word; exceptional verbal and written communication skills.
• Organizational with the ability to manage multiple tasks effectively .