Austin, Texas
Case Manager (Clinical Supervisor Job Opening in Austin, Texas - JOB DESCRIPTION SUMMARY
The Clinical Supervisor is responsible for coordinating home care services for managed care patients, which includes establishing and maintaining the patient?s plan of care, establishing and maintaining positive relationships with managed care customers and related referral sources, and negotiating service agreements
JOB RESPONSIBILITIES
Coordinates home care services for managed care patients, assists with the establishment of the plan of care in coordination with the physician and insurance Case Managers, and ensures a seamless transition to home care.
Collaborates with inpatient utilization review departments and managed care Case Managers to facilitate safe, early inpatient discharge.
Verifies insurance coverage, obtains initial authorizations for services, and seeks reauthorization for ongoing and additional services.
Works with Clinical Supervisors and staff clinicians to gather, collate, and report patient care summary information to managed care Case Managers.
Promotes maximum third party reimbursement through price negotiations with managed care Case Managers, within the established financial, credit, and contractual parameters.
Maintains comprehensive working knowledge of managed care contractual relationships and ensures that patients are admitted and services are delivered in accordance with contract provisions.
Works with members of the billing team to ensure that managed care customers are billed according to Case Manager Agreements.
Establishes and maintains positive working relationships with current and potential managed care customers.
Promptly responds to managed care customer?s requests and concerns.
Assists in building community, customer, and payer / patient perceptions of Capitol as a high quality provider of services.
Maintains comprehensive working knowledge in the field of managed care and shares information with appropriate organization personnel.
Maintains comprehensive working knowledge of community resources and assists customers in accessing community resources should services not be provided by Capitol.
POSITION QUALIFICATIONS
? Registered nurse in Texas with current licensure to practice professional nursing.
? Bachelor?s degree in Nursing from an accredited program by the National League for Nursing. Master?s degree in healthcare/hospice preferred.
? (3) years of recent health care managed care coordination, preferably in home health care.
? Complies with acceptable professional standards and practice.
? Must be a licensed driver with an automobile that is insured in accordance with state requirements and is in good working order.
? Has excellent observation, verbal, and written communication skills.
? Ability to market aggressively and deal tactfully with customers and the community.
? Demonstrates good communication, negotiation, and public relations skills.
? Demonstrates autonomy, organization, assertiveness, flexibility, and cooperation in performing job responsibilities.
? Excellent organizational and time management skills.
Job Type: Full-time
Salary: $80,000.00 /year
Required education:
Bachelor's
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