Case Manager

The Case Manager will have an innate ability to provide outstanding customer service to both the patients, families and referral sources. You will be responsible for part B authorizations.

Your Qualifications

• Experience in long-term or acute.
• Experience in case management or disease management.

Your Responsibilities

• Responsible for the management of therapy Part B authorizations
• Responsible for ensuring the continuity of care utilizing the appropriate resources within the parameters of established contracts and resident health plan benefits
• Attains prior authorization for Part B therapy services as directed
• Alert appropriate management team members regarding late or missing documents required for authorization approval
• Provide excellent customer service to patients, families and referral sources
• Ensure the members are receiving treatment from the therapy department that is clinically appropriate
• Direct line of communication to external insurance Case Managers
• Complete daily tracking log with updated status of authorization through approval
• Continued follow up with the Insurance/Medicaid representatives until request approved/denied
• Request and obtain continued authorizations while member is receiving therapy
• Submit initial therapy evaluations, doctor’s order and therapy notes to external Insurance/Medicaid providers within 24 hours
• Communication of authorization approvals and denials to management team
• Adhere to professional standards as outlined by protocols, rules and regulations
• Performs any miscellaneous work assignments as may be required
• Able to analyze various types of data reports

Outfield Healthcare Partners provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.