What are the responsibilities and job description for the Case Manager position at Avalon Health Care Management Inc.?
Avalon Healthcare Tacoma is now hiring a Case Manager to join our team!
The Case Manager will be responsible for facilitating interdisciplinary plans and assuring progress reports are completed and provided to payor as required; Also serves as liaison between patient, physician, care team members, payor, and the discharge planner by coordinating, monitoring, and communicating patient’s progress and cost evaluation and assisting with coordination to the next level of care.
$45.00 - $55.00 /hr
Full-time are eligible for:
- 401K
- Medical, Dental & Vision
- FSA & Dependent Care FSA
- Life Insurance
- AD&D, Long Term Disability, Short Term Disability
- Critical Illness, Accident, Hospital Indemnity
- Legal Benefits, Identity Theft Protection
- Pet Insurance and Auto/Home Insurance.
Responsibilities:
- Obtain prior authorizations
- Negotiates appropriate level of care within contract terms with the payor case manager
- Utilizes Letter of Agreement for non-contracted arrangements
- Communicates information to care team and coordinates patient's smooth transition to the next level of care.
- Obtains accurate information from physicians, patient, and payor source regarding the expected discharge plan and communicates this information to the interdisciplinary team
- Develops referrals from hospitals' social service and discharge planning departments, physicians, case managers, insurance companies and other referral sources
- Participates in Marketing Action Plan and Key Account Meetings and assumes Key Account Management responsibilities as directed by their supervisor.
- Visits hospital social workers, physicians, hospital discharge planners and administrators, attorneys, support organizations (i.e., oncology, stroke, head injury, etc.) civic/professional organizations, etc. to understand the need for program services and to communicate services offered which meet these needs to obtain referrals of patients
- Invites referral sources to nursing center and presents programs and presentations to support groups, insurance companies, self-insured industry, physicians, etc.
- Networks through case management organizations by attending community meetings regularly.
- Acts as a liaison between payors and decision makers facilitating a smooth transfer of information
- Assists in program evaluation as requested.
- Maintains primary focus of census development and revenue enhancement
- Provides documentation of contract or payor information on a timely basis to treatment team and business office billing staff, following case management policies
- Monitors that records pulled for insurance provider requests are complete and appropriate
Qualifications:
- Nursing background strongly preferred
- Associate degree in the health & human service field preferred.
- Current, active, and unrestricted licensure or certification in a health or human services discipline preferred
- Minimum two (2) years’ experience in medical case management preferred.
- Comprehensive knowledge of workers’ compensation, insurance, and managed care, required.
- Ability to negotiate coverage and provide complete and timely case management reports, required.
- Prior experience with an insurance company, private case management company, or HMO, preferred.
- Familiarity with long- term care and/or sub-acute care, useful.
- Strong oral and written communication skills, required.
If you are a highly motivated and experienced Case Manager with a passion for providing excellent patient care, we encourage you to apply for this exciting opportunity.
Salary : $45 - $55
