Health Insurance Case Manager

Avalon Health Care•Washington, PA

4h•$81,000 - $110,000

About The Position

Avalon Health Care Management in Yakima is now hiring a Case Manager to join our team! The Case Manager will be responsible for facilitating interdisciplinary plans and assuring progress reports are completed and provided to payor as required; Also serves as liaison between patient, physician, care team members, payor, and the discharge planner by coordinating, monitoring, and communicating patient’s progress and cost evaluation and assisting with coordination to the next level of care. $81,000 - $110,000 /yr

Requirements

Associate degree in the health & human service field preferred.
Current, active, and unrestricted licensure or certification in a health or human services discipline preferred
Minimum two (2) years’ experience in medical case management preferred.
Comprehensive knowledge of workers’ compensation, insurance, and managed care, required.
Ability to negotiate coverage and provide complete and timely case management reports, required.
Strong oral and written communication skills, required.

Nice To Haves

Nursing background strongly preferred
Prior experience with an insurance company, private case management company, or HMO, preferred.
Familiarity with long- term care and/or sub-acute care, useful.

Responsibilities

Negotiates appropriate level of care within contract terms with the payor case manager
Utilizes Letter of Agreement for non-contracted arrangements
Communicates information to care team and coordinates patient's smooth transition to the next level of care.
Obtains accurate information from physicians, patient, and payor source regarding the expected discharge plan and communicates this information to the interdisciplinary team
Develops referrals from hospitals' social service and discharge planning departments, physicians, case managers, insurance companies and other referral sources
Participates in Marketing Action Plan and Key Account Meetings and assumes Key Account Management responsibilities as directed by their supervisor.
Visits hospital social workers, physicians, hospital discharge planners and administrators, attorneys, support organizations (i.e., oncology, stroke, head injury, etc.) civic/professional organizations, etc. to understand the need for program services and to communicate services offered which meet these needs to obtain referrals of patients
Invites referral sources to nursing center and presents programs and presentations to support groups, insurance companies, self-insured industry, physicians, etc.
Networks through case management organizations by attending community meetings regularly.
Acts as a liaison between payors and decision makers facilitating a smooth transfer of information
Assists in program evaluation as requested.
Maintains primary focus of census development and revenue enhancement
Provides documentation of contract or payor information on a timely basis to treatment team and business office billing staff, following case management policies
Monitors that records pulled for insurance provider requests are complete and appropriate