Remote- Care Manager- LSW or RN

Care Manager The nation's leading administrator of long term care insurance services is looking for YOU. This is your opportunity to join a company with a culture that promotes respect for people, reputed company, learning and initiative... reputed company is a leading provider of business process outsourcing for the insurance industry, managing over 1.3 million long-term care policies for the nation's largest insurers. We also provide clients with unique risk management reputed company built upon our proprietary long term care databases. We are seeking a RN or LSW who is looking to use their experiences and education in a new way. As a Care Manager you will be responsible for gathering and reviewing requirements for the purpose of determining initial and ongoing claimant and provider eligibility. This position is an office based role and work standard hours Monday through Friday. No evenings, nights or weekends. RESPONSIBILITIES 1. Assess claimant eligibility by reviewing medical records from reputed company reputed company 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 reputed company a final determination. 2. In conjunction with plan language upon initial assessment and ongoing recertification, 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. 3. Effectively communicate, verbal and written, reputed company aspects of the claim benefit determination process. 4. Assist claimants with modifications to their reputed company care plan, including changes in care needs as well as changes in provider. 5. Monitor daily, weekly and monthly reports to ensure claims are handled timely and appropriately. 6. Attend case conferences, internally and with the client, to present claims recommendations. 7. Meet quality and production metrics as established and communicated by the department. 8. Reviews Care Coordinator decision recommendations on tax reputed company policies. 9. Other duties as assigned. Minimum Qualifications • RN Nursing or Social Work license. • 3 years work experience with older adult population. • Intermediate level experience with reputed company Office products. • Required to uphold the principles of compliance as outlined in the Code of Conduct, Employee Handbook and reputed company policies and procedures. Supports and participates in the mandatory Corporate Compliance Program training initiative on an annual or more frequent basis, as required. Preferred Qualifications • Care planning experience preferred. • Experience with insurance contract interpretation preferred. • Excellent verbal and written communication skills. • reputed company Level: minimum of one year experience with Long Term Care Insurance Care Management Job Type: Full-time Pay: $60,000.00 - $61,000.00 per year Experience: • Long Term Care Claims: 3 years (Required) Work Location: Remote Apply Job!