Managed Care Specialist (RN/LPN)

Brickyard Healthcare•Indianapolis, IN

16h•Hybrid

About The Position

We rely on and trust our Managed Care Specialist (RN or LPN) to provide centralized or field based case management for managed care and commercial insurance payers and residents. The right candidate for this role is a dedicated and compassionate team-player.

Requirements

Licensed as a Registered Nurse (RN) or Licensed Practical Nurse (LPN)
Must be capable of maintaining regular attendance

Nice To Haves

Minimum 2 years' experience with insurance providers preferred
Minimum 2 years' experience in a long-term care setting preferred

Responsibilities

Communicates care plan to insurance case managers with emphasis on strong discharge planning
Communicates, negotiates, and acts as liaison between Living Center/ Agency and the insurance plan to ensure proper level of payment is assigned for services provided
Communicates insurance benefits to all levels of associates
Understands provisions of contracts and associated exclusions
Work closely with facility and external support staff for negotiation of services and rates
Consults on appeals, retro authorizations and collections issues
Manage and maintain a live Spreadsheet to reflect changes in authorizations and continued stay reviews as they occur
Initiate, confirm and update facility and external staff on status of Authorizations
Work with insurance companies to ensure discharge disposition and documents are shared timely
Prep and submit insurance continued stay requests daily
Navigate the insurance, signing and return of NOMNC between insurance and facility staff
Obtain and Maintain copies of authorizations in member folders as well as in PCC documents
Submit requests for cost out of high-cost drugs with Prior authorizations as well as concurrent reviews