Job Title : Care-Manager
Job ID : R20020385
Location : Remote-Work from Home, US
Job Type : Full Time
Job Description Summary
As part of the Transamerica Long Term Care (LTC) division, the Care Manager develops specialized care plans for claimants, and provides chronically ill certifications as required by IRS federal guidelines.
- Develop care plans after a complete review of claimant medical records received from long term care providers.
- Review insurance eligibility assessments; document phone interviews with physicians, insured, and legal representatives.
- Provide chronically ill certifications and document claim records.
- Represent the Company in depositions.
- Assist claimants with modifications to care plan (i.e. changes in care needs, provider changes).
- Monitor daily, weekly, and monthly reports to ensure timely and appropriate handling of claims.
- Attend case conferences, internally and with the client, to present claims recommendations.
- Review decision recommendations made by Case Managers on tax qualified policies.
- Meet quality and production metrics established and communicated by the department.
- Maintain clinical license in good standing.
- Registered Nurse, or licensed Social Worker (LBSW, LMSW, LCSW)
- Four years of experience in case management, home care, acute care, or rehabilitation setting.
- Telephonic case management and/or home health care experience.
- Experience assessing and developing service plans for families with aging family members.
- Strong clinical skills and knowledge of chronic diseases.
- Understanding of common medications prescribed to the elderly.
- Strong written and oral communication skills.
- Customer focused with a high level empathy.
- Critical thinking skills to view claims holistically.
- Attention to detail to complete medication reconciliations.
- Time-management skills and the ability to handle competing priorities.
- Proficiency using MS Office tools.
- Care planning experience
- Office environment