Care Coordination and Utilization Manager

Company: ProMedica Senior Care
Location: Milford
Posted on: June 24, 2022

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