Job Description

We’re looking for a USRN Care Manager to join our Insurance Operations team at MBPS. In this role, you are expected to evaluate medical documentation and claim information against policy terms and conditions to determine eligibility for insurance benefits. Interprets policy language, analyzes medical evidence, and makes accurate claim decisions while ensuring compliance with contractual and regulatory requirements.

Position Responsibilities: 

  • Assess clinical needs and determine initial eligibility for long-term care benefits using clinical evidence and established guidelines.
  • Review onsite/virtual assessments, functional and cognitive screening results, and supporting documentation to make benefit eligibility decisions.
  • Monitor ongoing claims, particularly those with high-risk activity, and conduct clinical follow-ups in accordance with current protocols.
  • Collaborate with senior care management and cross-functional teams to ensure a...

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