Managed Care Case Manager, VNA of Cape Cod

Purpose of Position: The Managed Care Case Manager has the responsibility for organizing and evaluating the utilization of clinical services in partnership with the clinical team leaders for all managed care patients. Acts as a liaison between home care agency and insurance company.DescriptionConducts weekly IDT meetings with each POD on all managed care patientsOrganizes, directs, coordinates and evaluates the activities related to patient management.Manage benefits for best interest of home care agency and patientsReviews records to prevent denials and submits all required documentation in a timely mannerManage multi payer scenarios with logical plans of care and servicesProvide clinical expertise and serve as a resource to staffConduct team meetings and participate in interdisciplinary case conferences.Complete performance evaluations in a timely mannerRemove barriers to managed care patient dischargeProblem solve financial and medical issues and patient complaintsReviews clinical records for medical necessity, level of care and appropriatenessAll other duties as assigned.QualificationsCurrent LPN license in Massachusetts or Certified Occupational Therapy Assistant (COTA)Minimum eight (8) years clinical experience including two (2) in homecare/community preferred, health required and liaison experience a plusComputer skills preferred.Schedule Details: 37.5 Hours Per Week, Monday–Friday, 8a–4p, Occasional Weekends and Holidays Organization : Visiting Nurse AssociationPrimary Location : Massachusetts-HyannisDepartment : VNA-Home HealthAnnual/Hourly: UnassignedHiring Pay Range: 0 - 0