The RN Insurance Case Manager will be responsible for managing and processing all private/managed care insurance plans requiring authorization. This will include insurance plans for Home Health, Hospice and Hospice Home patients. The RN Insurance Case Manager will secure authorization for all private/managed care cases in a timely and accurate manner in order to maximize timely billing and prevent bad debt. Authorizations will be secure for all disciplines to include skilled nursing,physical therapy,occupational therapy,speech therapy,social work and certified nursing assistant. Clinical information required for authorization will be submitted as requested and required by insurance company. Patient visits will be tracked against authorization and maintained in a data base showing status/outcome. The RN Insurance Case Manager will communicate clinical information timely and effectively with clinical staff and private/managed care payers regarding medical necessity for authorizations. Will advocate for reauthorization and additional patient visits when medically necessary. Works closely with billing staff to facilitate timely and accurate billing to prevent denials and appeals. Keeps abreast of changes in private/managed care plans and communicate those changes to supervisor and staff.
Required - 1 year home health and /or hospice experience
Preferred - 3 -5 years home health/hospice experience, 2 years commercial insurance/case management experience