Managed Care Specialist (RN or LPN) at Brickyard Healthcare summary:
The Managed Care Specialist (RN or LPN) provides case management for managed care and commercial insurance payers, acting as a liaison to ensure proper payment levels for services. This role requires effective communication with insurance case managers and families to facilitate care plans and manage appeals. Ideal candidates are dedicated nurses with strong negotiation skills and a commitment to patient care.
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?
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- Excellent health benefits packages
- Career advancement opportunities
- Education reimbursement program of up to $7,500 per year
- Flexible scheduling available
Benefits & Conditions:
- No waiting period for enrollment
- Three health plan options
- Delta Dental
- VSP Vision
- Free Basic Life Insurance
- Disability, Critical Illness, Accident & Legal Coverage
- 401(k) Retirement Plan
- Employee Assistance Program
Responsibilities:
- Communicates, negotiates, and acts as liaison between Living Center/ Agency and the insurance plan to ensure proper level of payment is assigned for services provided
- Communicates care plan to insurance case managers with emphasis on strong discharge planning
- Communicates insurance benefits to all levels of associates and families
- Understands provisions of contracts and associated exclusions
- Provides cost analysis and negotiation of services and/or rates
- Consults on appeals, retro authorizations and collections issues
Qualifications:
- · Licensed as a Registered Nurse (RN) or Licensed Practical Nurse (LPN)
- · Minimum two (2) years clinical experience preferred
- · Minimum two (2) to three (3) years case management experience preferred
- · Must be capable of maintaining regular attendance
Keywords:
managed care, case management, healthcare, insurance, Registered Nurse, Licensed Practical Nurse, patient care, negotiation, care plan, health benefits