Managed Care Case Manager
- Secure initial authorization for all managed care admissions.
- Conduct timely and accurate concurrent reviews using PointClickCare and payer-specific portals.
- Submit clinical updates per schedule, documenting communications in PCC and any other systems required maintaining audit-ready files.
- Coordinate appeals for denied days with clinical team input and track resolution outcomes.
- Obtain and track authorizations for therapy (PT/OT/ST) and ancillary services such as diagnostics, wound care, and labs.
- Ensure utilization aligns with authorized units or timeframes; initiate reauthorization requests proactively.
- Collaborate with therapy department to maintain continuity of care and compliance with payer requirements.
- Oversee new and reauthorizations as required by plans
- Coordinate transitions of care and services with social services and family members.
- Monitor Medicaid Managed Care payer updates and benefit changes.
- Actively participate in Interdisciplinary Team (IDT) meetings to support coordinated care planning and discharge readiness.
- Attend and contribute to monthly financial meetings, providing data on reimbursement trends, avoidable days, and payer mix.
- Maintain and submit credentialing documents for managed care participation across all assigned facilities, collaborating with the business office or compliance as needed.
- Interface with admissions, therapy, MDS, nursing, and billing to support timely, accurate care delivery and billing.
- Participate in triple-check processes to ensure alignment between authorization, documentation, and claim submission.
- Educate facility staff on managed care policies, changes in payer rules, and documentation best practices.
- Background in healthcare authorizations, SNF admissions, or case management required. Preferred LPN/RN, BA, BSW, CCM or other
- Clinical background screening clinical packets for proper reimbursement leveling and capturing contract outliers/exclusions.
- Proven leadership experience in a senior management role.
- Strong understanding of healthcare regulations, compliance, and accreditation standards.
Recommended Jobs
Manager of Customer Experience - Logistics & Transportation
Job Description Job Description Description: LOGISTICS FOR THE INDUSTRIOUS At Venture, we help our clients deliver their products, their promises, and their potential every day. If you believ…
Dental Hygienist
Job Description Job Description Overview HealthDrive is currently seeking a Dental Hygienist , to work Full-Time (5 days per week) in greater-metro Detroit, MI and the surrounding areas. …
Machine Repair - (Metal Stamping equipment)
Job Description Job Description Hiring Bonus $1,000 500 after 90 days and 500 after 120 days Off shift- Machine Repair Must have experience in repair and troubleshooting large metal stampi…
Associate Veterinarian - Detroit, MI - #7942
Associate Veterinarian - Detroit, MI - #7942 Come work at a place where innovation and teamwork are highly valued. We are seeking an Associate Veterinarian to help provide excellent veterinary care.…
Contract UX/UI Designer L67755YW ( {{city}})
UX/UI Contract Designer (In-Office/Remote Hybrid) Location: Belleville, MI Contract Duration: 3 months with option to extend up to 2 times (total of 9 months) Hourly Rate: $40/hour Schedul…
Manager, Food Product Development
Job Description Job Description Company Description Domino’s Pizza, which began in 1960 as a single store location in Ypsilanti, MI, has had a lot to celebrate lately: we’re a reshaped, reen…
Caregiver
Job Description Job Description Benefits: Competitive salary Flexible schedule Training & development About Us: At ComForCare, we help make life easier and happier for people who n…
Experienced Snow Plow Driver
Job Description Job Description Job description Welcome to the Great Outdoors! We have immediate openings for Snow Removal Technicians. This position is a terrific way to make extra money during…
Carpenter
Job Description Job Description Freeman Construction is currently seeking skilled and reliable commercial carpenters to join our team for upcoming projects. We are looking for individuals who …
Customer Service Representative
- Professionally process outbound sales and/or customer service calls - Respond to customer questions - Resolve customer issues · Pray with those in need - Offer up-sells and cross-sells to ca…