…case management, physicians, Revenue Cycle teams and third-party payers. Collaborates with Managed Care Operations to mitigate revenue loss through payer

…DescriptionRegistered Nurse experience in field of case management with experience in managed care or insurance. Required 5 years' experience as an RN; that

…of standards such as NCQA, AHCA, OSHA, Joint Commission, and Medicare in the managed care setting* Proven ability to manage and direct various levels of

…Effectively managing key relationships with hospital therapists, physicians, key hospital staff, managed care providers, rehab suppliers, and other key referral

…not limited to:Have an understanding of MDS requirements for Medicare, Medicaid and Managed Care payers and Schedule MDS assessment as per those

…the referral process or insurance requirements Maintains appropriate logs required by Managed Care Carriers Processes charges Pulls charges from pending status

…care setting* 3+ years of appeals/grievances and utilization review experience at a managed care plan or provider organization and* Active, unrestricted RN or

…and to promote effective use of resources. Accurately interprets benefits and managed care products, and steers members to appropriate providers, programs

…the applicable medical policy and industry standards accurately interpreting benefits and managed care products and steering members to appropriate providers,

…equipment and nurse staffing budgets.Maintains current knowledge of applicable managed care , Medicare and state Medicaid regulations, reimbursement systems