Case Manager (Skilled Nursing) – Managed Care-HMO (RN/LPN/LMSW/LCSW)

Case Manager (Skilled Nursing) – Managed Care-HMO (RN/LPN/LMSW/LCSW)

Qualifications: Active licensure required as a RN, LPN, LMSW, or LCSW

Location: Valley Stream, NY (onsite)

Compensation: $75,000-$115,000 DOE & Credentialing

About the Role

We are seeking an experienced and detail-oriented HMO Case Manager to support skilled nursing facility (SNF) patients. The ideal candidate will have a strong background in healthcare, long-term care, or insurance, with at least 3 years of relevant experience.

Key Responsibilities

• Manage insurance-covered patient cases, including prior authorizations, continued stay reviews, clinical updates, denials, and appeals

• Coordinate, review, and submit clinical documentation to insurance providers in a timely manner

• Monitor case progress and advocate for appropriate levels of reimbursement

• Ensure denial letters and NOMNCs are issued, signed, and submitted to patients/families and insurance providers promptly

• Prepare and submit complete and timely appeals

• Build and maintain effective working relationships with insurance case managers

• Accurately document case activity, complete required forms, and communicate updates with facility staff and insurance providers

• Participate in utilization review meetings

• Conduct daily census reviews, including admissions, payer changes, and discharges

• Manage a high volume of phone calls, emails, and voicemails

• Maintain thorough, timely documentation of all communications

Qualifications

• Minimum 3 years of experience in healthcare, long-term care, or insurance

• Experience in SNF case management, MDS, social services, or admissions preferred

• Strong understanding of case management processes, authorizations, and reimbursement structures

• Proficiency with EMR systems and insurance portal platforms

• Knowledge of insurance verification and eligibility processes

• Clinical understanding of skilled nursing facility patients

• Excellent organizational, multitasking, and problem-solving skills

• Strong written and verbal communication skills

• Active licensure required: RN, LPN, LMSW, or LCSW

 
Why Join Us
This is an opportunity to play a critical role in patient advocacy and care coordination while working in a collaborative, fast-paced healthcare environment. Your expertise will directly impact patient outcomes and operational success.

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