Teamwork is what we're all about at Lexington Health Care. We realize that when you collaborate, great things are possible...for your patients, and for your career!
The Case Manager will be responsible for the coordination of care across the continuum of the patient’s care settings. This includes but not limited to the skilled nursing facility, home health care, assisted living facility and/or discharge to the community.
· Managed the day to day activities of patients who present with a Managed Care payor (PPO, POS, EPO, HMO and Medicare Advantage Plans) for the Lexington Health Care Centers.
· Assess patient’s clinical and current/prior level of functions (FIMS scores) for determination if admission to a Post-Acute Skilled Nursing Facility will meet Managed Care/Payor’s requirements (InterQual and Milliman and Roberts).
· Obtaining pre-certification and concurrent reviews with the Managed Care Payor’s Case Managers.
· Monitor care and identify variances to ensure appropriateness of length of stay per Managed Care/payor’s protocols.
· Determining and facilitation of Discharge Planning/Transition of Care appropriateness for the patient (Home Health, DME, NOMNC Letters).
· Communicate continued stay matters and complex cases with internal staff (Lexington Health Care Centers) and Managed Care Payor’s Case Managers.
· Collaborate with Internal Lexington Multidisciplinary Team to facilitate protocols/outcomes for Managed Care patients.
· Assist Corporate Billing Department with billing issue on behalf of patients/members.
· Utilize trend data to identify and evaluate effectiveness of delivery system.
· Prior Case Management and Insurance Experience
· CCM certification preferred
· Highly knowledgeable in Case Management practices and Managed Care Delivery Systems
· Strong Customer Service skills, organizational, planning, and problem solving skills
· Ability to communicate effectively with internal and external customers.
We offer excellent training & orientation, competitive compensation, comprehensive benefits, and numerous advancement opportunities.
Drug-Free Workplace. No Agencies, Please.