Utilization Management/Case Manager

1 day ago

Champaign, Illinois, United States Accolade Healthcare Full time

Accolade Healthcare

Utilization Management/Case Manager

About Us
At Accolade Healthcare, we put an emphasis on the satisfaction of our team members, understanding that a foundation built on quality patient care starts with the people providing the care. Our goal is to care for our staff with respect, empathy, and appreciation. Providing our professional staff with safe and efficient equipment to complete their mission is our priority. Accolade is committed to never being satisfied with industry norms and standards - instead, always searching for creative methods to equip our team with the tools necessary to achieve success.

Job Summary
As a
Utilization Management/Case Manager
at Accolade Healthcare, you will be responsible for coordinating the continuum of care for patients, with a strong focus on insurance authorizations, case management, and discharge planning. This role is vital to ensure that services are covered, appropriately authorized, and effectively managed to achieve optimal patient and financial outcomes.

Pay: $75,000-$90,000 annually
Benefits:

  • Medical, Dental, Vision and additional other voluntary benefits
  • 401k with company match
  • Generous Paid Leave Policy
  • Daily Pay partner

Responsibilities:
As a
Utilization Management/Case Manager,
your responsibilities include:

  • Coordinate and manage care for a caseload of SNF patients, ensuring timely authorizations and continued stay approvals.
  • Collaborate with interdisciplinary care teams, including physicians, therapists, social workers, and payors, to promote seamless transitions and quality care.
  • Obtain and manage insurance authorizations for inpatient SNF care, including commercial plans, Medicare Advantage, Medicaid, Workman's Compensation, No-Fault, and Single Case Agreements (SCA).
  • Negotiate reimbursement rates for non-contracted payors when necessary.
  • Review and respond to denials and discrepancies in authorizations; prepare appeal documentation and participate in QIO or health plan-level appeals as needed.
  • Identify patient care needs, assess insurance limitations, and work with the healthcare team to develop appropriate care plans.
  • Advocate for patient access to appropriate services while maintaining compliance with insurance guidelines.
  • Maintain accurate and up-to-date documentation in accordance with facility, insurance, and regulatory standards.

Skills and Qualifications:
To excel as a
Utilization Management/Case Manager,
you will need:

  • Licensed Registered Nurse (RN) or equivalent clinical credential preferred.
  • Minimum 2 years of case management experience, preferably in a SNF, hospital, or managed care setting.
  • Strong knowledge of insurance authorization processes, managed care, and appeal strategies.
  • Experience with Single Case Agreements, Workman's Comp, and No-Fault contracts.
  • Excellent communication, negotiation, and interdisciplinary collaboration skills.
  • Proficient in electronic health records and case management software.
  • Familiarity with CMS guidelines, QIO processes, and discharge planning protocols.
  • Ability to manage a high-volume caseload with a proactive and organized approach.
  • Knowledge of Medicare and Medicaid regulations specific to SNFs.

On-site or hybrid work environment depending on facility needs.

Fast-paced, patient-centered setting with frequent interaction with healthcare professionals and insurance representatives.

  • Case Manager

    2 weeks ago

    Champaign, Illinois, United States Rosecrance Full time $49,816 - $60,316 per year

    Become a champion of hope.At Rosecrance, we've been leading the way in behavioral health services for over a century. Our team empowers individuals and families to overcome substance use and mental health challenges through compassionate care and evidence-based therapies. If you're ready to make a meaningful impact, we're ready to welcome you We are looking...

  • Case Manager

    3 days ago

    Champaign, Illinois, United States Rosecrance Full time

    Become a champion of hope.At Rosecrance, we've been leading the way in behavioral health services for over a century. Our team empowers individuals and families to overcome substance use and mental health challenges through compassionate care and evidence-based therapies. If you're ready to make a meaningful impact, we're ready to welcome you We are looking...

  • Clinical Manager

    1 week ago

    Champaign, Illinois, United States Christie Clinic Full time $81,902 - $112,615

    Job Details Job Location:    University (LLC) - Champaign, IL Position Type:    Full Time Education Level:    2-Year Degree Salary Range:    $ $ Salary General Summary of DutiesChristie Clinic's department of Clinical Services is seeking a full-time Clinical Manager at the University clinic from Monday-Friday, with the ability to travel...

  • Civil/Utility Foreman

    2 weeks ago

    Champaign, Illinois, United States Accurate ProBuild Solutions Full time $60,000 - $80,000 per year

    Job SummaryRole and ResponsibilitiesLead and manage a crew of 2-4 employeesMaintain, submit, complete and accurate files/logs/pictures/reportsPerform on-site installation of each assigned project in coordination with the project managerReport any hazardous site conditions or accidents to appropriate personnelTake pictures of site conditions dailyPull...

  • Program Manager, Support for Workforce Training

    7 days ago

    Champaign, Illinois, United States Parkland College Full time

    Program Manager, Support for Workforce Training (SWFT)This position is a grant-funded, on-campus, full-time, 12-month appointment based in Champaign, Illinois covered by the Professional Support Staff (PSS) Union with an annual salary of $56,763.20.Application Close Date/Time: Tuesday, November 11th, at 6PM CTThe Program Manager for SWFT is responsible for...

  • General Manager(02921)

    1 day ago

    Champaign, Illinois, United States Domino's Franchise Full time

    Job Description ABOUT THE JOBYou were born to be the boss. We know. You get up in the morning and you make sure everyone else in the house is doing what they need to do. Then you go to work and you make sure that everyone there is doing what they need to do, even your boss. You just do that because you've always done it. Well maybe it's time you moved up....

  • Assistant Project Manager

    2 weeks ago

    Champaign, Illinois, United States William Charles Construction Company, LLC, a MasTec Company Full time

    William Charles Electric, a MasTec Company, is hiring an Assistant Project Manager that will work with the project team to support all documentation as well as QA/QC activities required under the contract in multiple projects. This position will also work with site superintendents to best utilize labor, equipment, and subcontractors.Location & Travel:You can...

  • Quality Lab Manager

    2 weeks ago

    Champaign, Illinois, United States Kraft Heinz Full time

    Job DescriptionJob Purpose Under the direction of the Site QA Manager/Associate Director – Manufacturing - Quality, the Quality Laboratory Manager is responsible for implementing, managing, monitoring and maintaining the plant's Microbiology & Analytical programs and corresponding equipment to ensure compliance to regulatory, federal, and local laws. The...

  • account manager

    4 days ago

    Champaign, Illinois, United States Yokogawa Full time

    Not just a job, but a careerYokogawa, award winner for 'Best Asset Monitoring Technology' and 'Best Digital Twin Technology' at the HP Awards, is a leading provider of industrial automation, test and measurement, information systems and industrial services in several industries.Our aim is to shape a better future for our planet through supporting the energy...

  • Pharmacy Manager

    1 week ago

    Champaign, Illinois, United States Nuvem Full time

    New Location - 819 Bloomington Road, Champaign, IL 61820; set to open in December.Official working hours yet to be determined - normally between M-F 8am - 5pm, with some exceptions Why? work for Nuvem:Opportunity to work closely with providers to deliver exceptional patient careWork Life BalanceNo nights, weekends, and closed most federal holidaysNuvem's...