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Case Management
3 months ago
[H.S. Diploma or Equivalent
**Hours**:
**Shift Start Time**:
8 AM
**Shift End Time**:
4:30 PM
**AWS Hours Requirement**:
**Additional Shift Information**:
Full Time - Day Shift
**Weekend Requirements**:
Every Other
**On-Call Required**:
No
**Hourly Pay Range (Minimum - Midpoint - Maximum)**:
$25.966 - $32.457 - $38.948
**What You Will Do**
This position supports case management/social work staff to meet department objectives, facilitate effective communication between department staff and the internal and external customers to the department, including but not limited to the business office, revenue cycle, payors, long term care, sub-acute facilities, and patients/families. Reviews complex request for medical care and services, if part of the discharge plan, inpatient admission, skilled nursing facility admission, including requests for outpatient care, retrospective claim review, durable medical equipment, medication issues and acquisition, home health, in accordance with payer guidelines. To provide support and help facilitate care coordination services provided by the Hospital Case Manager. This position is responsible for the care and services delivered to a specific hospital.
**Required Qualifications**
- H.S. Diploma or Equivalent
**Preferred Qualifications**
- Additional health related education
- Successful completion of Medical Assistant Program or equivalent
- 2 Years hospital experience.
- 2 Years Medi-Cal experience.
**Essential Functions**
- Collaboration of Clinical Resources
Prepares the inpatient census. Confirms report accuracy, makes modification as warranted to reflect accurate and current information.
Verifies current insurance plan eligibility. Reports statistics to the Director of Case Management.
Prepares paperwork for the Hospital Case Managers such as the actionable dashboard.
Reviews patient list and prioritize/plan for the day.
Generates phone calls to physician offices, health plans, and providers to assist in care coordination under the guidance of case managers including reviewing patient's need and condition with Skilled Nursing Facilities and Home Health Agencies for placement. Contributes to the continuous improvement initiatives of the hospital case management team to deliver quality interventions in a timely manner.
Deliver IMM letter to patient in accordance with hospital policy and procedure.
Assist the Hospital Case Manager by relaying information regarding patient demographics and the distribution of lists of contracted facilities for Skilled Nursing.
Maintains current communications with insurance and case managers.
Maintains current phone message log of payor phone calls.
Initiates and proactively collaborates with staff regarding frequently utilized community resources.
Acts as facilitator between payors and case managers.
Ensures case managers are updated daily and thought out the day as needed.
Schedules duties outside the office and breaks in collaboration with other assistants to ensure phone is answered in person at all times.
Keeps director, and leads apprised of status, including delays or inability to complete tasks.
Proactively notifies and reminds staff of meetings.
Maintains knowledge and skills required to perform co-assistant's specific duties (generation of a.m. paperwork for case managers, track case management assistant assignment logs as needed-temporary assistance, vacation coverage.)
Responsible for timely and accurate retrieval and appropriate action on departmental phone messages and necessary fax communication.
Assist case managers with ordering Durable Medical Equipment, following up with suppliers, and processing needed paperwork.
Work closely with revenue cycle to ensure the latest reimbursement and contract information is available to the case managers.
Work closely with the revenue cycle to make sure all are aware of denials real time.
Supports staff and leadership to meet department objectives.
- Database management
Assists with the processing of letters of appeal or denial.
Share with patient access list of patients who have not received initial Important Message from Medicare (IMM) and document initial IMM into Cerner.
Provide secondary IMM to patients according to policy and document in Cerner.
Prepare and send medical records in case of active appeal, especially from Medicare QIO.
Follow up on appeals and decisions, particularly from Medicare QIO.
Prepare databases and written reports for leads, manager, and director in a timely manner.
Consistently is up to date and current on all action taken on denials.
Initiates and participates in the creation and development of forms and lists.
Assist case managers and physician advisors with denial cases, setting up peer to peer reviews as needed.
- Department operations
Ensures CM/DCP/UM staff have appropriate resources and information to expedite smooth transition to through continuum and optimize third party payer reimbursement.
Develops and maintains compressive resource and referen
