Area Case Manager - (US-MA-Newburyport - 01951)

Minimum Education: None
Job Type: Full Time
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Responsibilities and Requirements : Provides Insurance and Managed Care oversight to ensure appropriate clinicalservices are provided and optimal reimbursement is obtained for each center within the district.Oversees and directs the centers within the district to ensure compliance withmanaged care policies and procedures and Kindred's guidelines and policies and procedures. This person serves as a key member of the district management team in helping the district develop quality Insurance and Managed Care programs within each center.Essential Functions:Oversees clinical reimbursement and utilization services within the district for Insurance and Managed Care residents.Directs and oversees the implementation of Kindred's utilization programs, policies andprocedures related to Insurance and Managed Care to ensure appropriatecare is rendered and appropriate reimbursement is obtained within each center within the districtMonitors the timely and effective service delivery for Insurance and Managed Care services while ensuring quality clinical outcomes with appropriate reimbursement for each centerMonitors the ancillary services provided at the centers to ensure the services are reasonable and necessary and with reasonable expense parameters.Advocates on behalf of the centers and district for needed resources and services within the reimbursement continuum.Provides education to other health care providers, the district team and center's care team on Insurance and Managed CareWorks as the liaison between the district, the center and rehabilitation as well as other care providersMonitors documentation and charting requirements that support services provided tomeeting billing requirements within each center.

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