Top Managed Care Executive jobs in Illinois

Description:

In support of Managed Care Case Management perform the duties of facilitating daily referral request for all Commercial, MMAI and Medicare Advantage plans for skilled care stays for all Aperion Care facilities. Case Management Consultant follows the patient from the time of Auth request to the time the patient discharges. This includes obtaining the original Auth, updates/extensions to the NOMNC.

RESPONSIBILITIES:

•In support of Managed Care Case Management perform the duties of triaging daily referralrequests for all Commercial, MMAI, and Medicare Advantage plans for skilled care stays for all Aperion Care Communities

•Responsible for obtaining authorization from Insurance companies on pending admissions.

•Working closely / communicating with each Community to obtain neededclinical/doctor/admission date to process each referral according to the Case Managementprocess.

•Communicates and maintains effective working relationships with marketing teams, facilitycontacts, and case management team as relates to referral process.

•Monitor the patient throughout the skilled stay by requesting current clinical from thecommunities and forwarding updates to the appropriate insurance company on the requestedupdate date.

•Issuing NOMNC’s 48 hours prior to last covered day on Medicare Advantage plans – perInsurance companies discretion.

•Accurately documents all benefits/authorization on Communities insurance verification sheetsand forward information to appropriate Community.

•Maintaining a positive team work / communication with the MCO Case Managementdepartment.

•Educate Aperion Community members on benefits and Insurance details concerning theirreferrals.

•Maintain a current log of all cases.

Skills, Knowledge, and Abilities Required:

•Self-Starter and results orientated personality

•Strong organizational, planning and problem-solving skills

•Able to work multiple tasks before a task is completed

•Understanding of the differences in types of insurance that is taken at a skilled nursing facility

•Working understanding of Medicare rules as it is applied to a skilled nursing facility

Preferred Requirements:

•Experience working in a skilled nursing facility

•Understanding of how claims are paid under Commercial and Medicare Advantage plans forskilled services.

•2 years working with MCO insurance experience is preferred