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Referral Case Manager

Nursing

SwedishAmerican Home Health Care

SAH HH ADMIN & GENERAL

Full Time

Day Shift

8 am - 5 pm Every third Saturday

80

Coordinates Referral center process and manages ongoing reimbursement management.  Responsible for Insurance investigation, negotiation and verifications. 

  • Graduate of an accredited School of Nursing program. 
  • At least one year experience as a professional nurse within the past five years in an acute care setting or two years in home care. 

Knowledge of insurance process, third party reimbursement requirements and regulatory standards.  Strong organizational skills, good judgment and ability to work in a team environment.  Ability to effectively communicate with physicians, patients, and their families and all levels of staff within the organization as well as with outside resources. 

Coordinates referrals from all sources and provides customer service following established procedures.  Evaluates client information to determine eligibility for home care services.  Provides appropriate information in compliance with third party payor reimbursement requirements to expedite payment for services.  Contacts third party case manager for initial verification of benefit and communicates approval for additional visits as appropriate.  Follows-up with case manages and rate negotiation.