Managed Care Specialist (RN or LPN) at Brickyard Healthcare summary:
The Managed Care Specialist (RN or LPN) is responsible for case management within managed care and commercial insurance, ensuring effective communication between healthcare providers and insurance companies. This role requires expertise in negotiating service payments and managing discharge planning while maintaining strong relationships with patients and families. Candidates should possess nursing credentials (RN or LPN) and experience in clinical and case management settings.
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, insurance negotiation, nursing, healthcare specialists, patient advocacy, discharge planning, clinical experience, LPN, RN