Managed Care Specialist

3 weeks ago


Plainfield, New Jersey, United States Brickyard Healthcare Full time
Managed Care Specialist (RN or LPN) at Brickyard Healthcare summary:
The Managed Care Specialist (RN or LPN) plays a crucial role in case management for managed care and commercial insurance payers, ensuring appropriate payment levels for services. This position involves communicating between the care facilities and insurers, along with providing insights for discharge planning and benefit communication. Qualified candidates are dedicated, have strong negotiation skills, and possess nursing licenses with experience in clinical and case management settings.

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?

Competitive Pay

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

Keywords:
Managed Care Specialist, case management, insurance negotiation, healthcare services, Registered Nurse, Licensed Practical Nurse, patient advocacy, health benefits, discharge planning, clinical experience

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