Clinical Reimbursement Case Management Manager, RN

Genesis Healthcare-posted 3 months ago
$89,000 - $89,000/Yr
Full-time • Manager
York, PA
5,001-10,000 employees
Nursing and Residential Care Facilities
Resume
Match Score
Upload and Match ResumeTrack Jobs with Teal

At Genesis Healthcare, we are dedicated to improving the lives we touch through the delivery of high-quality care and exceptional service. As a leading provider in the long-term care industry, we believe in fostering a collaborative, inclusive and supportive work environment where every team member is valued and empowered to make a difference. Whether you're an experienced professional or just starting your career, we offer opportunities for growth, development, and advancement in a range of roles. Join us in our mission to enhance the well-being of our patients and residents while making a meaningful impact in the communities we serve.

  • Responsible for the clinical, administrative, and financial oversight of the territory's center-based care management staff.
  • Oversees the personnel and processes necessary to ensure effective management of resource utilization, improving clinical outcomes, maximizing reimbursement, complying with contractual obligations and responding to the needs of payor customers.
  • Assists with the development, implementation, and maintenance of a case management model which meets clinical and financial goals.
  • Identifies business development opportunities for improved center specific clinical and administrative capabilities.
  • Develops systems to measure service utilization in assigned centers and identifies opportunities for improvement.
  • Collaborates to develop procedures for addressing clinical and administrative denials by payors and trains staff.
  • Manages relationships with third party payors ensuring timely responses to requests.
  • Establishes performance standards and productivity benchmarks for case management staff.
  • Supervises, monitors, and evaluates assigned staff, completing performance appraisals.
  • Identifies staff training needs related to managed care contracts and develops educational tools.
  • Works collaboratively to update strategic business plans and ensure deadlines are met.
  • Acts as case management interface with other departments and external customers.
  • Acts as a resource for staff for questions or issues in daily workflow.
  • Assists staff in securing authorizations for applicable exclusions and documents them.
  • Provides coverage plans for team members' time off.
  • Works with Team Members and Revenue Cycle Management Team to reduce AR/DSO and outstanding clinical accounts.
  • Assists with and completes special projects as assigned.
  • Graduate of an accredited School of Nursing with current RN licensure in the state of employment.
  • Bachelor's Degree in Nursing preferred.
  • Certified Case Management (CCM) or related clinical certification preferred.
  • Five to seven years of clinical nursing experience required.
  • Prior experience in utilization review, case management or discharge planning required.
  • Experience using evidence-based clinical decision support criteria (e.g. Interqual, Milliman) required.
  • Experience in rehabilitation nursing, acute care and/or the insurance field preferred.
  • Five years plus full time experience in case management preferred.
  • Management experience leading teams preferred.
  • Valid driver's license and automobile with appropriate insurance required.
  • Ability to adjust work schedule to changing business needs.
  • Experience managing virtual teams.
  • Variable compensation plans
  • Tuition, Travel, and Wireless Service Discounts
  • Employee Assistance Program to support mental health
  • Employee Foundation to financially assist through unforeseen hardships
  • Health, Dental, Vision, Company-paid life insurance, 401K, Paid Time Off
  • Several voluntary insurances available, including Pet Insurance, Term and Whole Life Insurance, Short-term Disability, Hospital Indemnity, Personal Accident, Critical Illness, Cancer Coverage
Track Jobs with Teal

Job Search Resources

•
Resume Builder
•
RN Case Manager Resume Examples
•
Cover Letter Examples

Tools

Career Hubs

Guides

Company

© 2024 Teal Labs, Inc
Privacy PolicyTerms of Service