Care Manager- LSW or RN

Responsibilities

• Assess claimant eligibility by reviewing medical records from all current providers and conducting phone assessments with the claimant or legal representative.
• In the event of noted inconsistencies in the claimant eligibility, coordinate a benefit eligibility assessment in order to make a final determination.
• Determine legitimacy and eligibility of service providers by requesting and reviewing provider licensing credentials, state-specific regulations, internet searches and phone assessments with the servicing provider.
• Effectively communicate, verbal and written, all aspects of the claim benefit determination process.
• Assist claimants with modifications to their current care plan, including changes in care needs as well as changes in provider.
• Monitor daily, weekly and monthly reports to ensure claims are handled timely and appropriately.
• Attend case conferences, internally and with the client, to present claims recommendations.
• Meet quality and production metrics as established and communicated by the department.
• Reviews Care Coordinator decision recommendations on tax qualified policies.
• Other duties as assigned.

Qualifications

• Bachelor’s degree in healthcare administration, social work, psychology, or related field.
• Minimum 2 years of experience in long-term care insurance, healthcare, or related field.
• Strong analytical skills and attention to detail.
• Excellent communication skills, both verbal and written.
• Proficiency in Microsoft Office Suite.

Skills

• Knowledge of long-term care insurance policies and regulations.
• Ability to work independently and manage multiple tasks simultaneously.
• Experience with data analysis and interpretation.
• Strong problem-solving and critical thinking skills.

Benefits

• Competitive salary commensurate with experience.
• Health, dental, and vision insurance.
• 401(k) retirement plan with company match.
• Flexible work schedule.
• Professional development opportunities.

Pay

• $XX.XX - $XX.XX per hour based on experience.

Schedule

• Full-time position.