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Pre-Cert Specialist

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Signature HealthCARE, LLC

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Location:
United States , Lexington

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Category:
-

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Contract Type:
Not provided

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Salary:

Not provided

Job Description:

Signature HealthCARE is a family-based healthcare company offering integrated services across multiple states. Our continuum of care includes skilled nursing, rehabilitation, assisted and memory care, and home-based services supported by innovative technologies like telehealth and Care.ai-enabled solutions. We are committed to advancing person-directed care and quality outcomes. Many of our facilities continue to receive high performance ratings and accreditations. As an award-winning organization recognized over the years by national outlets such as U.S. News & World Report, we take pride in fostering compassionate care environments and being an employer of choice in the healthcare industry. Overview: Responsible for acquiring managed care authorizations for assigned facilities following the managed care companies’ requirements. Pre-Cert Specialist is responsible for obtaining the appropriate reimbursement based on the negotiated Signature Healthcare contracts and securing any appropriate reimbursement for excluded items.

Job Responsibility:

  • Meet the physical and sensory requirements stated below and be able to work in the described environment
  • Working closely with Signature Intake Solutions to initiate and obtain managed care authorizations promptly via process used by Signature Healthcare
  • If a preferred vendor is required by the health plan for ancillary needs ( x-ray, pharmacy, ambulance, DME, etc) communicate that using Signature Healthcare Process
  • Documents authorizations, exclusions and other key information to the team using defined processes
  • Works as the liaison between the insurance pre-cert department and Signature to assure appropriate process are followed
  • Responsible for collaborating with other members of the managed care team as required to assure successful managed care outcomes
  • Ensures compliance with federal and state regulations as well as the Signature HealthCARE companies policies and procedures
  • Cooperatively works with the Sales and Marketing team
  • Conducts job responsibilities in accordance with the standards set by the Code of Conduct, Policies and procedures, applicable federal and state laws, and applicable professional standards

Requirements:

  • Registered Nurse or Licensed Practical/Vocational Nurse with current state license, preferred
  • Three (3) years’ experience in a Long-Term Care environment preferred working directly with Managed Care Services
  • Experience with the Case Management Process
  • Effective verbal and written English communication skills
  • Demonstrated advanced skills in Microsoft Word, Excel, Power Point and Outlook, Internet and Intranet navigation, and Adobe
  • Highest level of professionalism with the ability to maintain confidentiality
  • Customer service oriented with the ability to work well under pressure
  • Strong attention to detail and accuracy, excellent organizational skills with ability to prioritize, coordinate and simultaneously maintain multiple projects with high level of quality and productivity
  • Strong analytical and problem-solving skills
  • Ability to work with minimal supervision, take initiative and make independent decisions
  • Ability to deal with new tasks without the benefit of written procedures
  • Approachable, flexible and adaptable to change
  • Function independently, and have flexibility, personal integrity, and the ability to work effectively with stakeholders and vendors
What we offer:
  • Medical, Dental and Vision – Voluntary Life/Disability
  • 401(K) and Roth 401(K)
  • Tuition Forgiveness/Education Reimbursement
  • A variety of additional specialized Insurances
  • Pay Advance and Next Day Pay!
  • Paid Time Off (PTO)
  • Partner Perks and Discounts!
  • Reward & Recognition Program (HEART)
  • Vital Links

Additional Information:

Job Posted:
January 06, 2026

Employment Type:
Fulltime
Job Link Share:

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