Care Manager- RN or LSW

illumifin • Eden Prairie, MN

7d

About The Position

LTCG is seeking a Care Manager to gather and review information used to determine initial and ongoing claimant and provider eligibility for long-term care insurance benefits. The role assesses claimants and service providers, communicates benefit determinations, helps claimants modify care plans, monitors claim handling, and presents recommendations in case conferences. Candidates must hold an RN nursing or Social Work license and have experience working with older adults.

Requirements

• RN nursing or Social Work license.
• Three years of work experience with the older adult population.
• Intermediate-level experience with Microsoft Office products.
• Uphold compliance principles outlined in the Code of Conduct, Employee Handbook, and related policies and procedures; participate in mandatory Corporate Compliance Program training annually or more frequently as required.
• Excellent verbal and written communication skills.

Nice To Haves

• Care planning experience.
• Experience with insurance contract interpretation.
• For Lead Level: at least one year of experience in Long Term Care Insurance Care Management.

Responsibilities

• Assess claimant eligibility by reviewing medical records from current providers and conducting phone assessments with claimants or their legal representatives; coordinate a benefit eligibility assessment when inconsistencies are identified.
• Determine the legitimacy and eligibility of service providers during initial assessments and ongoing recertifications by reviewing plan language, provider licensing credentials, state-specific regulations, internet search results, and information gathered through phone assessments.
• Communicate all aspects of the claim benefit determination process verbally and in writing.
• Assist claimants with modifications to their care plans, including changes in care needs or providers.
• Monitor daily, weekly, and monthly reports to ensure claims are handled promptly and appropriately.
• Attend internal and client case conferences to present claims recommendations.
• Meet quality and production metrics established and communicated by the department.
• Review Care Coordinator decision recommendations on tax-qualified policies.
• Perform other duties as assigned.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed