Manager, Clinical Case Management - Registered Nurse at Generations Healthcare Network

Lincolnwood, Illinois, United States -

Full Time

Start Date

Immediate

Expiry Date

24 Dec, 25

Salary

110000.0

Posted On

25 Sep, 25

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

RN License, Clinical Nursing Experience, Case Management, Discharge Planning, Medicare Knowledge, Medicaid Knowledge, MCOs Knowledge, Commercial Insurance Knowledge, Utilization Review, Reimbursement, Electronic Medical Records, Communication Skills, Supervisory Experience, Audit Skills, Patient Assessment, Prior Authorization

Industry

Hospitals and Health Care

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 ~

Responsibilities

The Manager, Clinical Case Management is responsible for overseeing and coordinating the clinical and administrative aspects of patient care in a Skilled Nursing Facility. This includes managing prior authorization requests, ensuring compliance with payor contracts, and providing education to staff and families.