Care Manager, RN

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🔥 1 hour ago

🐊 Florida – Remote

🐊 Florida – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

👔 Manager

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Dayforce

WebsiteLinkedInAll Job Openings

5001 - 10000 employees

👥 HR Tech

☁️ SaaS

🏢 Enterprise

💰 $1G Post-IPO Debt - Dayforce on 2024-03

HR Tech • SaaS • Enterprise

Dayforce is a cloud-based human capital management (HCM) platform that delivers integrated payroll, HR, workforce management, talent management, and benefits administration for employers. It is offered as a software-as-a-service (SaaS) solution designed to help organizations manage employee lifecycle processes, payroll and scheduling in a unified system.

📋 Description

• Perform detailed clinical reviews of LTC claim files to determine eligibility in accordance with policy provisions and regulatory requirements. • Assess Activities of Daily Living (ADLs), cognitive impairment, diagnoses, comorbidities, and level of care needs. • Review medical records, Minimum Data Set (MDS) assessments, facility documentation, home health records, daily visit notes, and supporting claim forms. • Determine whether the insured meets the policy definition of Chronically Ill. • Prepare and document Chronically Ill Certifications (CICs) and individualized Plans of Care (POCs) for initial approvals and recertifications. • Clearly document clinical rationale to support benefit determinations. • Collaborate with Claims, Eligibility, and Customer Service teams to obtain additional documentation when necessary. • Maintain knowledge of LTC policy language, benefit triggers, and regulatory requirements.

🎯 Requirements

• Active, unrestricted Registered Nurse (RN) license required. • Clinical experience in long-term care, home health, geriatrics, case management, or utilization review preferred. • Experience reviewing medical records and assessing functional and cognitive impairment. • Knowledge of LTC insurance benefit triggers, ADL requirements, and chronically ill certification standards preferred. • Strong clinical judgment, critical thinking, and documentation skills. • Ability to manage multiple cases and meet turnaround expectations.