As part of the Stonerise Healthcare team, the Case Manager is to be responsible for providing leadership and management of clinical case management, clinical social work, utilization management, and discharge planning. The Case Manager assumes complete oversight of the precertification to skilled nursing centers as well as continued coverage throughout discharge. The Case Manager acts as an intermediary between the insurance provider, the health care provider and the patient.
Join us and benefit from the Stonerise difference. Our core values make us unlike any other employer. If you want to be part of a family-like team who feels as passionately about serving fellow members of your community as you do, join us!
In addition to competitive wages, you'll benefit from:
Area of assignment will be Morgantown/Monongalia County and surrounding areas.
Job Functions and Responsibilities:
Communicates with Interdisciplinary team daily to process managed care referrals, authorization for services, and maximize patients benefit for continued coverage throughout discharge.
Completes insurance verification of benefit and initiate authorization for admission.
Completes managed care assessment in PCC to summarize patient coverage and plan.
Participates in weekly IDT meetings to capture patient progress towards goal of next level of care.
Provides concurrent updates to managed care organizations timely to maximize benefit and length of stay.
Knowledgeable of managed care contracts to incorporate services provided for appropriate reimbursement.
Provides clear communication to IDT regarding patients benefit and last covered day of services.
Completes managed care assessment to finalize services for billing accuracy.
Responsible for organizing and maintaining documentation of clinical record for submission to managed care organizations.
Establishes and maintains a positive and professional relationship with current and potential providers and works to ensure patient and provider satisfaction.
Maintains comprehensive working knowledge of Stonerise Healthcare markets and promotes a working relationship among its affiliates.
Demonstrates excellent communications, negotiation, and public relations skills.
Demonstrates autonomy, organization, assertiveness, flexibility and cooperation in performing job responsibilities.
Knowledge of Corporate Business Management
Ability to communicate effectively verbally and in writing.
Superior customer service skills, including ability to resolve conflict.
Ability to work independently and with a team.
Experience in Managed Care authorization and/or review.
Stonerise Healthcare LLC