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Posted: Wednesday, August 30, 2017 10:43 PM

LAUREL BROOK REHABILITATION AND HEALTHCARE CENTER : MOUNT LAUREL, NJ Laurel Brook Rehabilitation and Healthcare Center is hiring a Managed Care Specialist. The Managed Care Specialist provides direct oversight to facility care navigators and external case managers/ clinical liaisons to support the delivery of effective and efficient patient care. Oversees utilization management and transition management for patients within the assigned caseload. Partners with Social Workers, Care Navigators, and external case managers/ clinical liaisons and collaborates with other health care team members to identify appropriate utilization of resources and to ensure reimbursement. Marquis Health Services is one of the Northeasts leading providers in Subacute Rehabilitation and Skilled Nursing Facilities. As the healthcare subsidiary of the three:generation family:owned organization, Tryko Partners, Marquis Health Services has been helping patients live the best possible lives within their facilities through a wide:range of exceptional rehabilitative services. We offer competitive wages, a comprehensive benefits package and in:house advancement opportunities through our continuous education and training opportunities. PBachelorA?s degree in Business or Health Management, advanced degree preferredMinimum of 5 years of extensive, direct experience in contract negotiation5 years direct operational experience in a multiple site outpatient facility setting including profit and loss responsibility3 years direct supervisory experienceAbility to manage databases and provide analysis Responds to inquiry calls from hospital discharge planners, families, facilities, and other referral sources. Manages the admission process by maintaining updated bed availability and facility services information at all times. Manages the inquiry process professionally, timely and with appropriate follow:up. Effectively manages occupancy levels and census/premium mix enhancement. Must be able to multi:task.Develops and maintains relationships to advise referral sources of bed availability and new product and services. And efficiently meets and daily needs of the community at large. Maintains current database of existing and potential referral sources.Alerts appropriate department heads and building staff of projected changes, i.e. admissions, bed changes, and discharges, via phone, to discuss forthcoming changes. Utilizes bed management principles. Maintains a close working relationship with the Director of Nursing (DNS) and the Business Office Account Manger to assure appropriate and efficient decisions about prospective admissions. Recommends admission decisions to facility management.When admissions determinations are made, communicates with facility staff to initiate appropriate room and bed municates special needs of new admits to staff to ensure a smooth transition. Ensures daily that referral sources and admissions data are entered into the automated referral system.Manages multiple inquiries and presents referral to appropriate facilities based on location and services provided.Maintains a working knowledge of Federal and State regulations and reimbursement guidelines (Medicare and Medicaid). Verifies managed care referrals and negotiates initial rate and communicates to facility.Monitors and evaluates customer satisfaction. Audiences might include referral sources, new admissions, post discharges, current residents and families (via Corporate Family Survey), community sources and inquires that were unable to admit. Shares results with the management team, PI committee, and others as appropriate to develop action plans, as needed.Determines medical necessity, appropriateness of admission, continuing stay and level of care using a combination of clinical information, clinical criteria, and third party information. Intervenes when determinations are not in alignment with clinical information, clinical criteria or third party information to resolve the situation. Coll

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• Location: Central Jersey

• Post ID: 43959193 centraljersey
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