Regional HMO Case Manger - Care Network

Virtue Clinical Solutions is actively seeking an experienced Regional Managed Care Manager to oversee Managed Care programs for skilled nursing facilities. This position is suited for a healthcare professional with a robust background in skilled nursing care management and a keen ability to lead remote teams.

Experience Requirements:

• Required: Minimum of 1-3 years direct experience in skilled nursing facilities, with specific skills in obtaining Managed Care authorizations and appeals 
• Preferred: Over 5 years of experience, including supervisory roles overseeing team members and managing complex healthcare operations, preferably within managed care environments.

Responsibilities:

• Manage and track authorizations for HMO patients across multiple skilled nursing facilities.
• Supervise a team of case managers, and managed care coordinators ensuring seamless communication between Admissions, Social Work, Rehab, and Billing departments.
• Lead critical care committees and enhance overall service delivery and patient care.
• Coordinate with insurance case managers to discuss patient care plans, progress, and discharge plans, and advocate for patient care.
• Compile appeal packages for denied services or coverage.
• Promote ongoing professional development and ensure staff competencies align with the highest standards of care.

Qualifications:

• In-depth knowledge of Medicare, Medicaid, and Commercial Insurance guidelines, including specific programs like HARP, AARP, Obamacare, No-Fault, and Workers Comp.
• Experience within skilled nursing facility settings.
• Strong leadership capabilities with demonstrated skills in mentoring and developing remote teams.
• Proficient in Microsoft Excel and Word; exceptional verbal and written communication skills.
• Organizational with the ability to manage multiple tasks effectively .