Job detail

Managed Care Case Manager - Corporate Hybrid Positiont

Legacy Health Services

#Interdisciplinary Team #HIPAA #Regulatory Requirements #Care Coordination #Managed Care #Discharge Planning #Quality Improvement #Long-Term Care

Quick overview

The Case Manager will act as a liaison between patients, payors, physicians, and care teams to ensure timely, accurate, and cost-effective care coordination throughout the post-acute skilled stay. Key duties include maintaining contract knowledge, negotiating care levels, coordinating transitions, completing authorizations, and serving as the primary point of contact for care coordination.

Requirements summary

Candidates must possess a Bachelor's degree in healthcare or a related field, or a licensed clinical degree, along with at least two years of experience in a healthcare setting. Strong knowledge of managed care, insurance, and workers' compensation is required, alongside exceptional communication and problem-solving abilities.

bachelor degreeprofessional certificateCase ManagementCommunicationCustomer ServiceTime ManagementDocumentationNegotiationHIPAA ComplianceMicrosoft OfficeCare CoordinationConflict ResolutionAppealsUtilization ReviewBilling Reviews

Job description

Legacy Health Services is seeking a detail‑oriented and collaborative Managed Care Case Manager to join our Managed Care team.
In this role, you will serve as a key liaison between patients, payors, physicians, and interdisciplinary care teams to ensure timely, accurate, and cost‑effective care coordination throughout the post‑acute skilled stay.
This position is essential in supporting smooth transitions of care, utilization review, and optimal patient outcomes.
Key Responsibilities 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.
Qualifications Required: 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.

Managed Care Case Manager - Corporate Hybrid Positiont

Quick overview

Requirements summary

Job description

Benefits

Preferred

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