Why You'll Love Working With Us:
- Comprehensive Health Benefits: Enjoy top-tier health, dental, and vision insurance.
- Generous PTO: Take advantage of ample paid time off for a healthy work-life balance.
- Professional Development: Access to continuous learning and development opportunities.
- Collaborative Environment: Work with a team of passionate and dedicated professionals.
- Modern Facilities: State-of-the-art clinic with the latest technology and equipment.
Looking for someone experienced in :
- Claims Accuracy
- Appeals and Denials Management
- Pre-authorization and concurrent reviews
Job Summary:
As a Case Manager, you will assess the psycho-social needs of patients, initiate necessary arrangements for resources and discharge plans, provide counseling to patients and families, and conduct individual and group therapy sessions. Your role is essential in ensuring that our patients receive the comprehensive care they need for successful treatment and recovery.
Essential Responsibilities:
- Counseling individual patients and family members.
- Making recommendations and referrals to home health and community agencies as needed.
- Being knowledgeable in the “Baker Act” and other Mental Health Laws.
- Coordinating discharge planning according to criteria for all patients, re-evaluating and modifying the plan as needed.
- Assisting with program planning, development, and evaluation.
- Performing intake assessments/evaluations of treatment needs, including completion of psychosocial history and creation of treatment plans.
- Determining eligibility for social, medical, financial, and other services to meet patient needs.
- Communicating psychosocial aspects of treatment with the multi-disciplinary team and acting as a resource for treatment planning.
- Monitoring compliance and observing for adverse reactions to medications in the elderly population.
- Ascertaining therapeutic modalities that meet the needs of elderly patients.
- Consulting with physicians regarding patients' treatment plans and needs.
- Implementing crisis intervention measures when indicated.
- Conducting individual and group therapy sessions, including Insight Oriented and specialty groups.
- Researching and evaluating community resources and referral sources.
- Participating in cross-functional CQI, safety, and infection control studies.
- Being flexible with scheduling to meet patient and family needs for discharge planning and counseling.
Skills and Abilities:
- Address age-specific needs of the adult and geriatric population in all interventions.
- Maintain a professional level of conduct and appearance.
- Display good public and guest relations by being friendly and cheerful.
- Exhibit good judgment and tact when dealing with complaints and policy enforcement.
- Use personal judgment and specialized knowledge to provide information.
- Communicate effectively, speak clearly, and listen carefully.
- Adhere to Company policies and procedures.
- Maintain confidentiality of patient information.
- Assist patients and families with their needs.
- Multitask efficiently.
- Accurately operate switchboards or computer keyboards.
Qualifications:
- Education and/or Experience:
- Associates degree in Nursing; Bachelor's in Nursing preferred.
- Minimum of two years of inpatient hospital experience with CM/UR/DCP experience preferred.
Job Type: Full-time
Benefits:
- 401(k)
- Dental insurance
- Employee assistance program
- Flexible schedule
- Health insurance
- Life insurance
- Paid time off
- Retirement plan
- Vision insurance
Schedule:
- 4x10
- 8 hour shift
- Rotating weekends
Application Question(s):
- Do you have experience with : Preauthorization and Concurrent Reviews: Case managers work with insurers to obtain preauthorizations and conduct concurrent reviews, ensuring that treatments are covered and minimizing out-of-pocket expenses for patients. This also helps secure timely reimbursements for the hospital?
- Do you have experience with Claims Accuracy: if so please explain in detail example?
Experience:
- Preauthorization and concurrent reviews: 3 years (Required)
- Insurance verification: 1 year (Required)
Ability to Commute:
Work Location: In person