Case Manager/Medicaid Coordinator

Job Title: Insurance Case Manager

About Us: Waterview Nursing Care Center is a leading provider of comprehensive short-term and long-term care services, dedicated to enhancing the quality of life for our residents. We are committed to providing compassionate and personalized care, and we’re looking for a skilled Insurance Case Manager to join our team and help us continue to deliver exceptional care.

Position Summary: The Insurance Case Manager will be responsible for managing insurance-related aspects of resident care within our nursing home facility. This role involves coordinating with insurance providers, residents, and families to ensure that all necessary documentation and approvals are in place for optimal care coverage. The ideal candidate will have a strong understanding of insurance policies, excellent organizational skills, and a commitment to providing exceptional service to our residents and their families.

Key Responsibilities

Insurance Coordination

• Serve as the primary point of contact for insurance companies, residents, and families regarding insurance-related issues.
• Review and verify insurance policies, coverage details, and eligibility for residents.
• Ensure that all required authorizations and referrals are obtained in a timely manner.

Documentation and Compliance

• Prepare and submit insurance claims, appeals, and other documentation as needed.
• Maintain accurate and up-to-date records of insurance-related communications and transactions.
• Ensure compliance with facility policies, insurance regulations, and state and federal guidelines.

Resident and Family Support

• Provide guidance and support to residents and families regarding insurance benefits and coverage.
• Address any insurance-related concerns or questions from residents and their families with empathy and professionalism.
• Assist with the appeals process for denied claims or coverage issues.

Collaboration and Communication

• Work closely with healthcare providers, social workers, and administrative staff to coordinate care and resolve insurance-related issues.
• Facilitate communication between residents, families, and insurance providers to ensure clear understanding of coverage and benefits.

Continuous Improvement

• Stay informed about changes in insurance policies, regulations, and industry best practices.
• Identify and recommend improvements to processes related to insurance management and documentation.

Qualifications

Education

• Bachelor’s degree in healthcare administration, business, or a related field preferred. Relevant experience may be considered in lieu of a degree.

Experience

• Experience in insurance case management or a similar role, preferably in a healthcare or nursing home setting.
• Strong knowledge of insurance policies, billing procedures, and regulatory requirements.

Skills

• Excellent organizational and time management skills with a keen attention to detail.
• Strong interpersonal and communication skills, with the ability to handle sensitive information with confidentiality and professionalism.
• Proficient in using insurance management software and other relevant tools.

Working Conditions

• Full-time position with standard working hours.
• Work environment is primarily indoors, within a nursing home facility setting.

Why Join Us?

• Competitive salary and benefits package.
• Opportunity to make a meaningful impact on the lives of our residents and their families.
• Supportive and collaborative work environment.

How to Apply: Interested candidates should submit their resume.

Waterview Nursing Care Center is an equal-opportunity employer and encourages applications from individuals of all backgrounds and experiences.