Insurance Case Manager

POSITION SUMMARY

The Insurance Case Manager is responsible for overseeing and coordinating insurance benefits, authorizations, utilization review, and managed care processes for residents receiving skilled nursing and rehabilitation services. This position plays a critical role in ensuring timely insurance approvals, maintaining appropriate reimbursement, monitoring authorized lengths of stay, and preventing avoidable denials or financial losses. The Insurance Case Manager works collaboratively with the Admissions Department, Nursing, Therapy, Social Services, Business Office, and interdisciplinary team to ensure residents receive medically necessary services while maximizing reimbursement opportunities and maintaining compliance with payer requirements.

KEY RESPONSIBILITIES

• Verify residents' insurance coverage, benefits, eligibility, and payer requirements.
• Obtain and manage insurance authorizations for skilled nursing, rehabilitation, and continued stays.
• Submit clinical documentation to insurance companies to support medical necessity and authorization requests.
• Monitor authorization dates, approved lengths of stay, and benefit limits to prevent coverage interruptions.
• Coordinate concurrent reviews and provide timely clinical updates to insurance companies.
• Communicate insurance approvals, denials, and changes in coverage to the appropriate facility departments.
• Identify potential coverage issues and proactively address authorization delays or denials.
• Review insurance denials and assist with appeals, reconsiderations, and supporting documentation.
• Work closely with Admissions to review insurance benefits and authorization requirements for incoming residents.
• Collaborate with Nursing, Therapy, and Social Services to obtain necessary clinical information and support continued stay requests.
• Monitor payer guidelines, insurance regulations, and managed care requirements.
• Maintain accurate records of authorizations, insurance communications, and utilization review activities.
• Assist with identifying reimbursement opportunities and reducing avoidable financial losses related to insurance coverage.
• Ensure all insurance-related activities are completed accurately, timely, and in compliance with applicable regulations and facility policies.

QUALIFICATIONS

• Previous experience in insurance case management, utilization review, managed care, or healthcare reimbursement preferred.
• Experience in a skilled nursing facility, rehabilitation center, or long-term care setting strongly preferred.
• Knowledge of Medicare, Medicaid, Medicare Advantage, and commercial insurance plans.
• Understanding of insurance authorizations, clinical documentation, medical necessity, and appeals processes.
• Strong organizational, communication, and problem-solving skills.
• Ability to manage multiple priorities and meet deadlines.
• Proficiency in Microsoft Office and electronic medical record systems.

WHY JOIN OUR TEAM?

• Competitive compensation
• Full-time employment opportunity
• Collaborative and supportive work environment
• Opportunity to make a meaningful impact on resident care and facility operations

Apply today to join our team!