Rn case manager Jobs in Windsor, ON

Case Management Coordinator, Full Time

Ontario, California Facility Kindred Hospital Ontario

Req ID 529110 Post Date 04 / 23 / 2025

Description

Pay Range :   $22.38- $28.38

We would expect those hired into this job would be paid within this pay range, however, certain circumstances may allow us to pay outside of this range.

ScionHealth is committed to a culture of service excellence as demonstrated by our employees’ adherence to the service excellence principles of Pride, Teamwork, Compassion, Integrity, Respect, Fun, Professionalism, and Responsibility.

As our most acute level of care, our specialty hospitals offer the same critical care patients receive in a traditional hospital or intensive care unit , but for an extended recovery period. Our clinicians play a vital role in the recovery process for chronic, critically ill and medically complex patients.

Job Summary

Under the supervision of the Director of Case Management (DCM) or designee, completes various duties to enhance the efficiency of the Case Management Department, as well as support the daily functions of the Case Managers. This role assists in securing arrangements for the discharge transition and post-acute services. Works with the Case Management team to monitor and obtain insurance verifications and concurrent authorizations. Assists with denial prevention and management as requested, aiding with the peer-to-peer coordination, and denials / appeals tracking. This position serves as a liaison between the Case Management department, payers, post-acute providers and various other entities.

Essential Functions

• Provides assistance to the Case Management staff, including, but not limited to; creating and sending referral packets, organizing admission and discharge patient records, making phone calls, obtaining signatures, or any other assistance needed as determined by the DCM.
• Assists the Case Management team in scheduling family conferences.
• Assists the Case Management team by making necessary arrangement for post-discharge follow-up care.
• Functions as the point of contract and liaison for the hospital Case Management department staff regarding clinical insurance review completion and / or issues.
• Forwards the necessary patient clinical information for all admission, concurrent, and retrospective insurance reviews to payers for the completion of medical necessity reviews.
• Monitors, follows-up, documents and tracks payer responses / requests of completed clinical reviews, including; approvals, appeals and denials and communicates these to the appropriate people (hospital staff, physicians, DCM, Case Manager(s), Clinical Denial Management, and Centralized Business Office {CBO}).
• Monitors and tracks the total hospital certified days of the patient for payers (commercial, managed care, and Medicaid) and communicates missing certifications to the DCM, Case Manager(s), and CBO.
• Initiates and completes insurance pre-certification for patients lacking certification. Communicates pre-authorization outcomes to appropriate individuals (hospital and CBO).
• Organizes and prepares the necessary clerical elements for the weekly Interdisciplinary Team Meeting and other Case Management meetings.

Knowledge / Skills / Abilities / Expectations

Qualifications

Education

Licenses / Certification

Experience