Care Coordination and Utilization Manager
Company: ProMedica Senior Care
Location: Milford
Posted on: June 24, 2022
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Job Description:
DescriptionProMedica Senior Care provides a range of services,
including skilled nursing care, assisted living, post-acute medical
and rehabilitation care, hospice care, home health care and
rehabilitation therapy.Job SummaryThe Care Coordinator and
Utilization Manager (CCUM) plays an integral role in optimizing the
plan of care for Managed Care patients. The CCUM is responsible for
the timely compilation, review and submission of medical
information relating to the post-acute skilled stay. By serving as
the liaison between the patient, physician, interdisciplinary care
team members, and the payer; this position coordinates, monitors,
advocates and communicates the patients progress and cost
evaluation while assisting with and coordinating an efficient and
smooth coordination to the next level of care.In return for your
expertise, you'll enjoy excellent training and unlimited
opportunities to learn and grow. Be a part of the team leading the
nation in healthcare.Care Coordination and Utilization Manager
ResponsibilitiesMaintains a strong working knowledge of all managed
care contracts for their assigned area of responsibility.Negotiates
appropriate levels of care for contracted and non-contracted terms
with the payor case manager.Communicates information to care team
and coordinates patient's smooth transition to the next level of
care.Obtains accurate information from physicians, patient, and
payor source regarding the expected discharge plan and communicates
this information to the interdisciplinary team.Complies with key
department expectations for care coordination and utilization
including:Manage assigned caseload efficiently and effectively
utilizing time management skills.Reviews and ensures clinical
documents for insurance provider requests are complete and accurate
prior to submission.Complete continued stay reviews and update
extended authorizations timely in addition to coordinating and
monitoring length of stay for alternative payor models. Enter
timely and accurate documentation in MCO portals as required. Act
as a liaison between payors and interdisciplinary team facilitating
a smooth transfer of information.Manage the care plan throughout
the continuum of care as a single point of contactLocation481 -
ProMedica Skilled Nursing and Rehabilitation - Allentown,
PAEducational RequirementsCollege degree in the health & human
service field required. Current, active, and unrestricted licensure
or certification in a health or human services discipline
preferred.Position RequirementsMinimum two (2) years experience in
medial case management. Comprehensive knowledge of workers'
compensation, insurance, and managed care, required. Ability to
negotiate coverage and provide complete and timely case mgmt
reports, required. Prior experience with an insurance company,
private case mgmt. Company, or HMO, preferred. Familiarity with
long- term care and/or sub acute care, useful. Strong oral and
written communication skills, required.
Keywords: ProMedica Senior Care, Bethlehem , Care Coordination and Utilization Manager, Executive , Milford, Pennsylvania
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