What are the responsibilities and job description for the Managed Care Coordinator position at Curis Services?
SUMMARY : In support of Managed Care Case Management perform the duties of triaging daily referral requests for all Commercial, MMAI, and Medicare Advantage plans for skilled care stays for all facilities. Insures all required information is provided before handing off to Case Managers. Performs insurance verifications for commercial plans as well as plan benefits verifications for all referrals.
ESSENTIAL DUTIES AND RESPONSIBILITIES :
- Primary liaison between marketing liaisons, facilities admissions and MCO Case Management for new referrals and readmissions.
- Communicates and maintains effective working relationships with marketing teams, facility contacts, and case management team as relates to referral process.
- Performs review of referral requests for completeness of information and determines when ready to move to a case manager for preauthorization.
- Perform benefit verifications on all referrals adhering to appropriate processes.
- Able to hold facilities accountable to adhere to the process for referrals to case management of MCO cases.
- Maintain / Close out Manage Care Referral Log.
- Assistant to Case Management Consultant – Obtaining Auth, communication with communities, and communication with insurance companies.
QUALIFICATIONS : To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements below are representative of the knowledge, skill, and / or ability required.
PHYSICAL DEMANDS : The physical demands are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
