Care Manager

We’re looking for a Care Manager to join our Insurance Operations team at MBPS. In this role, you are expected to use your clinical expertise to assess clinical information on low to moderate exposure claims, following established business protocols. You will validate and interpret clinical evidence against policy or plan provisions to determine benefit eligibility for Long-Term Care (LTC) claims.

Position Responsibilities

• Assess clinical needs to determine initial eligibility for long term care benefits
• Ongoing monitoring of claims for high-risk activity
• Make benefit eligibility determinations based on onsite/virtual assessments, functional/cognitive screening forms and/or other clinical evidence on ongoing claims
• Appropriately set clinical follow updates based on current protocols
• Complete trainings as assigned to maintain currency with protocol and guideline updates
• Collaborate with other busines...