Managed Care Case Manager

Legacy Health Services is seeking a detail‑oriented and collaborative Managed Care Case Manager to join our Managed Care team. In this role, you will serve as a key liaison between patients, payors, physicians, and interdisciplinary care teams to ensure timely, accurate, and cost‑effective care coordination throughout the post‑acute skilled stay.

This position is essential in supporting smooth transitions of care, utilization review, and optimal patient outcomes.

Key Responsibilities

Maintain strong working knowledge of all managed care contracts within assigned areas. Negotiate appropriate levels of care with contracted and non‑contracted payors. Coordinate smooth patient transitions and communicate discharge plans to interdisciplinary teams. Obtain and verify clinical and discharge information from physicians, patients, and payors.

Complete timely reviews, authorizations, and documentation within MCO portals. Serve as primary point of contact for care coordination throughout the continuum of care. Participate in interdisciplinary team discussions to support care planning, identify barriers, and monitor progress. Educate and train new team members on contract terms and case management processes.

Communicate insurance coverage and benefits to patients and families as needed. Assist with billing reviews, collections support and appeals as appropriate. Ensure patient confidentiality and compliance with HIPAA and regulatory requirements. Participate in monthly P&L reviews and support quality improvement initiatives.

Attend required in‑service trainings, orientations, and key account meetings. Provide coverage for other Case Managers as needed. Consistently model customer service principles and support the organization’s mission and values.

Qualifications

Bachelor’s degree in healthcare or a related field, OR a licensed clinical degree. 2+ years of experience in a healthcare setting. At least 1 year of Case Management experience preferred. Strong knowledge of workers’ compensation, insurance, and managed care. Exceptional verbal and written communication skills. Strong problem‑solving, negotiation, conflict‑resolution, and time‑management skills.

Proficiency with Microsoft Office (Word, Excel, PowerPoint). Preferred: Experience in long‑term care, sub‑acute care, or working for an insurance company, private CM, or MCO. Why Legacy Health Services? Healthcare is a calling and being part of a family owned and operated company that will invest in YOU will turn that calling into a career.

Legacy Health Services offers many career path opportunities, including options for those who are new to healthcare. Whether you want to become a nursing assistant, advance from LPN to RN licensure, obtain your BSN or simply sharpen your skills in a fast paced, rewarding environment, we have a role for you. We are proud to offer: Comprehensive benefits package including health, dental, vision, disability, and life insurance Company sponsored educational opportunities including wound care certification classes for nurses Career advancement opportunities 401(k) with company match through Fidelity Legacy Health Services is a family-owned and operated post-acute care company based in Parma, Ohio.

“Our Family Caring for Yours” is as true today as it was when the company was created over fifty years ago. Legacy Health Services provides a complete continuum of care that includes skilled nursing, assisted living, rehabilitation services, long-term care and affiliates that provide full-time nurse practitioners and hospice care.

We provide our residents with compassionate care and quality services to meet all of their needs, both clinical and non-clinical. We value each of our residents as individuals, with unique physical, spiritual, social, emotional and intellectual needs. Our goal is to treat everyone like family- with compassion, respect and kindness.

To learn more, visit lhshealth.com We are an Equal Opportunity Employer and consider all applicants for positions without the regard to race, color, religion, sex, national origin, age, national orientation, age, sexual orientation, marital or veteran status, or non-job related handicap or disability.