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Job Description
Join Brickyard Healthcare as a Managed Care Specialist (RN or LPN) to provide centralized case management for managed care and commercial insurance payers. This role requires a compassionate team player dedicated to ensuring the best care for residents.
Key Responsibilities
Communicates care plan to insurance case managers with emphasis on strong discharge planning
Acts as liaison between Living Center/ Agency and the insurance plan to ensure proper level of payment
Communicates insurance benefits to all levels of associates
Understands provisions of contracts and associated exclusions
Works closely with facility and external support staff for negotiation of services and rates
Consults on appeals, retro authorizations and collections issues
Manages and maintains a live Spreadsheet for authorizations and stay reviews
Initiates, confirms and updates status of Authorizations
Works with insurance companies to ensure timely sharing of discharge disposition and documents
Preps and submits insurance continued stay requests daily
Navigates the insurance signing and return of NOMNC between insurance and facility staff
Obtains and maintains copies of authorizations in member folders and PCC documents
Submits requests for cost out of high-cost drugs with Prior authorizations and concurrent reviews
Required Qualifications
Licensed as a Registered Nurse (RN) or Licensed Practical Nurse (LPN)
Minimum 2 years’ experience with insurance providers preferred
Minimum 2 years' experience in a long-term care setting preferred
Must be capable of maintaining regular attendance
Benefits & Perks
Competitive PayExcellent health benefits packagesCareer advancement opportunitiesEducation reimbursement program of up to $7,500 per yearFlexible scheduling availableNo waiting period for enrollmentThree health plan optionsDelta DentalVSP VisionFree Basic Life InsuranceDisability, Critical Illness, Accident & Legal Coverage401(k) Retirement PlanEmployee Assistance Program