Managed Care Case Manager, VNA of Cape Cod

The Managed Care Case Manager has the responsibility for organizing and evaluating the utilization of clinical services in partnership with the clinical team leaders for all managed care patients. Acts as a liaison between home care agency and insurance company.

Description:

• Conducts weekly IDT meetings with each POD on all managed care patients
• Organizes, directs, coordinates and evaluates the activities related to patient management.
• Manage benefits for best interest of home care agency and patients
• Reviews records to prevent denials and submits all required documentation in a timely manner
• Manage multi payer scenarios with logical plans of care and services
• Provide clinical expertise and serve as a resource to staff
• Conduct team meetings and participate in interdisciplinary case conferences.
• Complete performance evaluations in a timely manner
• Remove barriers to managed care patient discharge
• Problem solve financial and medical issues and patient complaints
• Reviews clinical records for medical necessity, level of care and appropriateness
• All other duties as assigned.

Qualifications:

• Current LPN license in Massachusetts or Certified Occupational Therapy Assistant (COTA)
• Minimum eight (8) years clinical experience including two (2) in homecare/community preferred, health required and liaison experience a plus
• Computer skills preferred.

Schedule Details: 37.5 Hours Per Week, Monday–Friday, 8a–4p, Occasional Weekends and Holidays

Organization: Visiting Nurse Association

Primary Location: Massachusetts-Hyannis

Department: VNA-Home Health

Annual/Hourly: Unassigned

Hiring Pay Range: $0 - $0