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Manager, Clinical Case Management - Registered Nurse

Manager, Clinical Case Management - Registered Nurse

Generations Healthcare NetworkLincolnwood, IL, US
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Job Description

Job Description

Description :

Manager, Registered Nurse Clinical Case Management - Generations Healthcare Network, Lincolnwood, IL

Generations Healthcare Network , a Consortium of Skilled Nursing Facilities, seeks an Experienced RN Case Manager for its Four Skilled Nursing Facilities in Northern Illinois and Northeast Indiana. Please note : this is NOT a Social Services position. Please read the job qualifications below before applying.

The Manager, Clinical Case Management, must be a RN and will be responsible for overseeing and coordinating the clinical and administrative aspects of patient care in a post-acute Skilled Nursing Facility (SNF) setting. The RN Case Manager serves as a liaison between the facilities, interdisciplinary teams, and payor sources in an effort to optimize outcomes, reimbursement, and regulatory compliance, while also supporting facility leadership.

50% travel between facilities is required. This is NOT A remote role.

We offer you a Salary between $85k and $110k, and you are Eligible for Company Benefits, including Choice of Health Care Plans, 401k w / Company Match, Dental, Vision and Life Insurance, Health Savings Account, and Much More!

Apply Today!

Qualifications of the Manager, Case Management :

  • RN License, Illinois
  • 2-3 years’ clinical nursing experience, with at least 1 year of case management and discharge planning. SNF and / or post-acute setting highly preferred
  • Knowledge of Medicare, Medicaid (HFS), MCOs and commercial insurance processes, including prior authorizations, appeals, contract compliance and services agreements
  • Familiarity with post-acute levels of care and transitions
  • Understanding of payor contract structure
  • Supervisory level experience with utilization review, reimbursement, and case management preferred
  • Proficiency with electronic medical records and payor portals
  • Excellent written and verbal communication skills; ability to interact with physicians and payers as well as residents and their families

#IND1

Requirements :

Duties of the Manager, RN Case Management :

  • Assessment of residents’ level of care throughout stay through utilization review
  • Initiate and manage prior authorization requests with Medicare Advantage, MCOs and commercial payors
  • Respond to denials, initiate appeals, track resolutions
  • Ensure compliance and accurate billing in terms of payor contracts
  • Participate directly with (re)negotiation of services agreements with various contracting entities
  • Serve as primary point of contact with health plan representatives
  • Regular travel to facilities required to provide departmental oversight and ensure payor engagement
  • Provide education to staff, residents and families regarding insurance, discharge and care options
  • Audit medical records to ensure thorough and accurate documentation
  • Track patient progress against goals
  • Generations Healthcare Network is one of the industry’s leading consulting firms and premier providers of skilled nursing and rehabilitation services. Generations Healthcare Network is a newly minted brand to advance a generations long and successful tradition deeply rooted in the firm belief of providing quality healthcare services in warm, inviting, safe and amenities-filled facility environments.www.generationshealthcarenetwork.com

    ~ Our Family Caring for Your Family for Generations to Come ~

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    Registered Nurse Case Management • Lincolnwood, IL, US

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