Case Manager

Legacy Health Services • Oregon, OH

13d • Onsite

About The Position

Orchard Villa is seeking a detail‑oriented and collaborative Case Manager (CM) to join our Managed Care team. In this role, you will serve as a key liaison between patients, payors, physicians, and interdisciplinary care teams to ensure timely, accurate, and cost‑effective care coordination throughout the post‑acute skilled stay. This position is essential in supporting smooth transitions of care, utilization review, and optimal patient outcomes.

Requirements

• Bachelor’s degree in healthcare or a related field, OR a licensed clinical degree.
• 2+ years of experience in a healthcare setting.
• Strong knowledge of workers’ compensation, insurance, and managed care.
• Exceptional verbal and written communication skills.
• Strong problem‑solving, negotiation, conflict‑resolution, and time‑management skills.
• Proficiency with Microsoft Office (Word, Excel, PowerPoint).

Nice To Haves

• At least 1 year of Case Management experience preferred.
• Experience in long‑term care, sub‑acute care, or working for an insurance company, private CM, or MCO.
• An Ohio LPN/RN or Therapist license

Responsibilities

• Maintain strong working knowledge of all managed care contracts within assigned areas.
• Negotiate appropriate levels of care with contracted and non‑contracted payors.
• Coordinate smooth patient transitions and communicate discharge plans to interdisciplinary teams.
• Obtain and verify clinical and discharge information from physicians, patients, and payors.
• Complete timely reviews, authorizations, and documentation within MCO portals.
• Serve as primary point of contact for care coordination throughout the continuum of care.
• Participate in interdisciplinary team discussions to support care planning, identify barriers, and monitor progress.
• Educate and train new team members on contract terms and case management processes.
• Communicate insurance coverage and benefits to patients and families as needed.
• Assist with billing reviews, collections support and appeals as appropriate.
• Ensure patient confidentiality and compliance with HIPAA and regulatory requirements.
• Participate in monthly P&L reviews and support quality improvement initiatives.
• Attend required in‑service trainings, orientations, and key account meetings.
• Provide coverage for other Case Managers as needed.
• Consistently model customer service principles and support the organization’s mission and values.

Benefits

• A strong sense of purpose and community
• Opportunities to grow your career in skilled nursing, assisted living, rehab, long-term care, and hospice
• Full-time nurse practitioner support and interdisciplinary collaboration
• A workplace that values your unique contributions and encourages continuous learning

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level