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Conducts clinical rounds with MCO representatives (as necessary). Provides accurate and timely clinical documentation and updates to the MCO as required. Participates in Case Management calls/ meetings. Responsible for education and training of the interdisciplinary team regarding contract rates and terms, case management process and procedures, and IDT role in the managed care process. Assist AR to assure accurate billing including monthly review of UB04’s. Monitors census and profitability of the Managed Care patients. Negotiates appropriate levels of care within the contract terms with payer case managers. Negotiates letters of agreement and rates for non-contracted payers as appropriate. Acts as a liaison between the payers and the interdisciplinary team. Communicates pertinent information to the IDT team timely. Provides documentation of contract or payer information and authorization approval on a timely basis to the IDT team, following the Case Management policy. Works collaboratively with the IDT team to drive outcomes- LOS, discharge planning, MCO expectations.
Education and Training:
• Graduate of an RN or LPN program.
**Two (2) years of Clinical practice experience, background in managed care, worker’s compensation and/or insurance.
Skills and Abilities:
• Ability to work flexible hours (evening/weekends as needed).
• Ability to work with a diverse population. Ability to communicate effectively, written and verbally.
• Knowledge of computers, including proficiency in Microsoft Office applications and the Internet.