Manager, Case Management

Manager, 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.

The Manager, 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 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

Duties of the Manager, 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 ~