Clinical Case Manager (Wound Care)

About the role

This is a full-time remote role for Clinical Case Manager.

Responsibilities

• Verify patient insurance coverage/benefits using online portals or calling the Payor directly for accuracy.
• Document coverage results in our online software application.
• Review patient clinical for payor medical necessity and initiate prior authorization or predetermination with payor.
• Follow up with payor and maintain communication with sales team and customer.
• Report out the patient benefits and authorization/predetermination results to external customers via online application or email/fax.
• In the case of a denial, work with the customer and payor through the appeal process.

Qualifications

• Clinical qualifications such as RN, LPN or medical assistant.
• 2-4 years of experience is preferred.
• Understanding of health insurance plans, patient benefits, and coverage.
• Tech-savvy with the ability to adapt to system changes.
• Proficient in Excel and Adobe.
• Excellent written and verbal communication skills.