Internal Case Manager Position Available In Androscoggin, Maine

Internal Case Manager at Genesis Healthcare in Lewiston, Maine, United States Job Description Overview At Genesis Healthcare, we are dedicated to improving the lives we touch through the delivery of high-quality care and exceptional service. As a leading provider in the long-term care industry, we believe in fostering a collaborative, inclusive and supportive work environment where every team member is valued and empowered to make a difference. Whether you’re an experienced professional or just starting your career, we offer opportunities for growth, development, and advancement in a range of roles. Join us in our mission to enhance the well-being of our patients and residents while making a meaningful impact in the communities we serve. Responsibilities The Case Manager ensures a collaborative process of assessment, planning, facilitation and advocacy for options and services to meet the patient/resident’s health needs with quality and cost-effective outcomes as the priorities.

• Monitor patients’ case throughout stay to ensure utilization of services are in accordance with plan of care and to minimize the financial risk to patient and center.
• Verify and communicate current, accurate and complete clinical information to payer from patient Pre-Admission through Concurrent Review using standard and plan review forms to justify clinical necessity according to payer review schedule.
• Review Pre-Admission Review (PAR) and IRM Pre-Authorization assessment to identify costly treatments, supplies or services.
• Communicate contract terms for patients’ stay to the interdisciplinary team and ensure the team implements services in the patient plan of care subject to contract terms and case negotiations in order to minimize overutilization or under-utilization of services and unreimbursed claims.
• Negotiate for appropriate continuation of length of stay or extension of services and appropriate level of care and associated rates.
• Obtain payer authorization for recommended treatments, procedures, supplies, equipment and medications and all exclusions. Qualifications
• Must be a graduate of an accredited School of Nursing with current RN licensure in the state where employment occurs or where case management is practiced contingent upon state regulations required.
• Five years of recent clinical nursing experience is required.
• Prior experience in utilization review, case management or discharge planning is required.
• Must have previous experience using evidence-based clinical decision support criteria.
• Must have advanced knowledge of third party r