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Managed Care Specialist

4 months ago

Franklin, United States Brickyard Healthcare Full time


We rely on and trust our Managed Care Specialist (RN or LPN) to provide centralized or field based case management for managed care and commercial insurance payers and residents. The right candidate for this role is a dedicated and compassionate team-player.


Why Work For Us?  





    • Excellent pay with multiple incentives:


    • Excellent health benefits packages
    • Career advancement opportunities
    • Education reimbursement program of up to $7,500 per year 
    • Flexible scheduling available



Benefits & Conditions:



  • No waiting period for enrollment
  • Three health plan options
  • Delta Dental
  • VSP Vision
  • Free Basic Life Insurance
  • Disability, Critical Illness, Accident & Legal Coverage
  • 401(k) Retirement Plan
  • Employee Assistance Program

Responsibilities:



  • Communicates, negotiates, and acts as liaison between Living Center/ Agency and the insurance plan to ensure proper level of payment is assigned for services provided
  • Communicates care plan to insurance case managers with emphasis on strong discharge planning
  • Communicates insurance benefits to all levels of associates and families
  • Understands provisions of contracts and associated exclusions
  • Provides cost analysis and negotiation of services and/or rates
  • Consults on appeals, retro authorizations and collections issues

Qualifications:



  • · Licensed as a Registered Nurse (RN) or Licensed Practical Nurse (LPN)

  • · Minimum two (2) years clinical experience preferred

  • · Minimum two (2) to three (3) years case management experience preferred

  • · Must be capable of maintaining regular attendance