[Hiring] Renal Clinical Case Manager @Pentec Health

Role Description

Our Renal Clinical Case Manager provides clinical expertise in management of IDPN and IPN therapies. This role manages internal aspects of therapy approval and authorization and assists with all clinical aspects needed for reimbursement within our Revenue Cycle Management team.

• FOR THIS ROLE YOU MUST BE LOCATED IN PACIFIC OR MOUNTAIN TIME ZONE: OREGON, WASHINGTON STATE, IDAHO, NEVADA AND ARIZONA
• Acts as clinical Subject Matter Resource for Renal Dietitians, Nurses, Nephrologists, Account Executives and/or other field staff as well as Revenue Cycle Management staff.
• Participates in the Quality Management overview reviewing current and proposed processes and improvements.
• Assists in developing renal program to increase the client base for IDPN/IPN and other forms of Parenteral and Enteral Nutrition (PEN) and related services.
• Provides Clinical Assistance for all patients within the territory with routine evaluation and monitoring of patients requiring IDPN and IPN nutritional therapies.
• Responsible for coordinating with the CSR and AE to assure monthly labs and payor required documents are obtained for all active patients on therapy and assists AE by reviewing the queue.
• Completes all necessary forms, documents and letters/statements of medical necessity as needed by renal centers, dialysis chains or payors.
• Escalates insurance denials as needed, in conjunction with Insurance Coordinators and/or Billers/Collectors, to payors to obtain approvals for coverage through telephone consultations or via written appeal letters.
• Is available to organize or assist with CEU and Web-Ex CEU seminars; conduct live displays and educational sessions regarding the use of IDPN/IPN and other nutritional therapies.
• Other job duties and special projects as assigned.

Qualifications

• BS degree in Nutrition or equivalent/related field.
• Must be a Registered Dietitian or Licensed Nutritionist as required by state, for at least two years.
• 1-2 years of practical experience in a full-service Dialysis facility.
• Experience in renal nutrition, especially in CKD 5 Dialysis, along with experience in dialysis related parenteral nutrition support therapies is required (IDPN required; IDPN/IPN preferred).
• Able to work autonomously and make independent decisions within generally accepted medical practices, regulations and guidelines.
• Intermediate computer skills with programs such as Microsoft Office Suite: Outlook, Word, Excel and Power Point.

Requirements

• Must be located in Pacific or Mountain Time Zone: Oregon, Washington State, Idaho, Nevada, and Arizona.

Benefits

• Comprehensive compensation and full benefits package.
• Medical, dental, vision.
• 401k match.
• PTO, paid holidays.
• Disability and life insurance.
• Employee assistance.
• Flexible spending or health savings account.
• Other additional voluntary benefits.

Salary Range

$72,000.00 Annual