Job Description

Your Job
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.

Job Tags

Local area,

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Case Manager Job at Outfield Healthcare Partners, Albuquerque, NM

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