Case Manager LPN

Limitlessli

107d

About The Position

At Limitlessli, we specialize in recruiting, hiring, and managing high-caliber remote staff for dynamic and growing healthcare facilities. Leveraging our extensive global network, we connect clients with highly qualified professionals, offering tailored services to meet our clients' unique business needs. We are seeking a highly motivated and detail-oriented Licensed Practical Nurse (LPN) with strong experience in MDS coordination, Managed care, and Triple check processes. The Case Manager will be responsible for coordinating patient care, ensuring compliance with regulatory guidelines, and supporting reimbursement accuracy through effective utilization of managed care resources. This role requires strong clinical judgment, excellent communication skills, and the ability to collaborate across interdisciplinary teams. This position is remote and offers you the flexibility of working from home.

Requirements

• Current Licensed Practical Nurse (LPN) in good standing [State-specific license required].
• Minimum of 2+ years of experience in case management, utilization review, or related nursing role.
• Hands-on experience with MDS assessments and knowledge of CMS guidelines.
• Knowledge and prior experience in managed care processes and insurance authorizations.
• Familiarity with triple check process for billing and reimbursement.
• Strong organizational, communication, and problem-solving skills.
• Ability to work independently and collaboratively in a fast-paced healthcare environment.
• Proficient in electronic medical records (EMR) systems and Microsoft Office Suite.

Nice To Haves

• Prior experience in long-term care, skilled nursing, or rehabilitation settings.
• Working knowledge of Medicare/Medicaid reimbursement guidelines.
• Certification in Case Management (CCM or ACM) a plus, but not required.

Responsibilities

• Coordinate and oversee patient care plans in collaboration with physicians, therapists, and nursing staff.
• Manage MDS (Minimum Data Set) assessments to ensure timely and accurate submission in accordance with federal and state regulations.
• Review, monitor, and manage managed care authorizations, ensuring patients receive appropriate and approved services.
• Participate in triple check processes to ensure accuracy of billing, coding, and clinical documentation.
• Communicate regularly with insurance providers, patients, and families regarding care plans and coverage.
• Monitor patient progress, outcomes, and transitions of care to reduce readmissions and optimize quality of care.
• Maintain compliance with regulatory requirements, company policies, and professional standards.
• Serve as a resource for staff education and training related to managed care, MDS, and documentation standards.
• Assist with audits, reporting, and quality assurance initiatives.

Benefits

• Flexibility of working from home.
• Collaboration with an international team.

What This Job Offers

• Career Level: Mid Level
• Education Level: No Education Listed