Nurse Case Manager (RN/LPN)

Job Type Full-time Description

Symphony Care Network is looking to hire a Nurse Case Manager (RN/LPN) living in Michigan or Illinois to support the facilities in those locations

•  Managed the day to day activities of patients who present with a Managed Care payor (PPO, POS, EPO, HMO, and MMAI (Dual Eligible) for the Symphony Post Acute Network Facilities.
• Verify, interpret and apply patient’s benefits as it relates to Skilled Nursing.
• Assess patient’s clinical and current/prior level of functions (ADL’s and FIMS scores) for determination if admission to a Sub Acute Skilled Nursing Facility will meet Managed Care/Payor’s requirements (InterQual and Milliman Care Guidelines).
• Obtain pre-certification and authorizations to admit patients to ensure approval and financials.
• Ability to compare reimbursement per Contract terms vs. cost of patient to perform ROI component. 
• Review and submit concurrent reviews to the Managed Care Payor.
• Determination and facilitation of Discharge Planning/Transition of Care appropriateness for the patient (Home Health, DME, NOMNC/Non-Coverage Letters).
• Communicate continued stay matters and complex cases with internal staff (Symphony Facilities) and Managed Care Payor.
• Collaborate with internal Symphony Multidisciplinary Team (Clinical, Therapy, Social Services, Admissions, Business Office, and Billing) to facilitate protocols/outcomes for Managed Care patients.
• Understand, interpret and apply managed care payor contracts for the appropriate leveling of patient for reimbursement and any carve-out/stop loss clauses.
• Assist Corporate Billing Department with billing issue on behalf of patients/members.
• Timely submission of reports or data as needed.

Qualifications and Education Requirements

• Bachelor's degree in healthcare, management or finance or a related field.
• 2+ years of experience working in healthcare or related field
• RN/LPN 

Requirements

  

· Advanced level of knowledge of Managed Care practices/protocols. 

· Ability to communicate professionally and effectively.

· Strong organizational, planning and problem solving skills

· Experience using data systems/Electronic Medical Records (EMR) specifically Point Click Care.

· Proficient in Outlook, Microsoft Word, and Excel

Salary Description Starting at $65,000 Apply