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Managed Care Case Manager
Legacy Health ServicesManaged Care Case Manager coordinating care for patients in a corporate hybrid environment. Engaging with payors, physicians, and care teams to ensure quality patient outcomes.
About the role
Key responsibilities & impact- Maintain strong working knowledge of all managed care contracts within assigned areas
- Negotiate appropriate levels of care with contracted and non‑contracted payors
- Coordinate smooth patient transitions and communicate discharge plans to interdisciplinary teams
- Obtain and verify clinical and discharge information from physicians, patients, and payors
- Complete timely reviews, authorizations, and documentation within MCO portals
- Serve as primary point of contact for care coordination throughout the continuum of care
- Participate in interdisciplinary team discussions to support care planning, identify barriers, and monitor progress
- Educate and train new team members on contract terms and case management processes
- Communicate insurance coverage and benefits to patients and families as needed
- Assist with billing reviews, collections support and appeals as appropriate
- Ensure patient confidentiality and compliance with HIPAA and regulatory requirements
- Participate in monthly P&L reviews and support quality improvement initiatives
- Attend required in‑service trainings, orientations, and key account meetings
- Provide coverage for other Case Managers as needed
- Consistently model customer service principles and support the organization’s mission and values
Requirements
What you’ll need- Bachelor’s degree in healthcare or a related field, OR a licensed clinical degree
- 2+ years of experience in a healthcare setting
- At least 1 year of Case Management experience preferred
- Strong knowledge of workers’ compensation, insurance, and managed care
- Exceptional verbal and written communication skills
- Strong problem‑solving, negotiation, conflict‑resolution, and time‑management skills
- Proficiency with Microsoft Office (Word, Excel, PowerPoint)
Benefits
Comp & perks- Comprehensive benefits package including health, dental, vision, disability, and life insurance
- Company sponsored educational opportunities including wound care certification classes for nurses
- Career advancement opportunities
- 401(k) with company match through Fidelity