Case Management Coordinator

4 weeks ago

Rapid City, South Dakota, United States Monument Health Full time
Job Summary

Monument Health is seeking a skilled Case Management Assistant to support the Case Management/Social Work functions related to payer pre-authorizations/notifications, utilization review submissions, education of patients and families regarding required regulatory notices, assists with patient discharge arrangements, specialized administrative assistance, record keeping and general care-coordination tasks as assigned by Case Management/Social Work partners.

Key Responsibilities:

* Collaborate with the healthcare team, patients/families, payers, physician offices and other community agencies to ensure a team environment.
* Demonstrate excellent customer service skills in all interactions to provide a smooth and efficient department operation allowing for maximum comfort and confidentiality for the customer.
* Prioritize workflow and know when to ask for help.
* Verify and obtain benefits levels from insurance carriers and employers when applicable and maintain appropriate and accurate documentation, both written and electronically.
* Maintain working knowledge of procedures and insurance requirements.
* Responsible to obtain the necessary knowledge and experience to perform job tasks in compliance with federal, state, and local laws, regulations and guidelines.
* Maintain compliance with all department policies and procedures. Completes Medicare Message follow up letter and Medicare Outpatient Observation Notices as identified by department process.
* Educate patients and families on coverage and coordination progress as directed by Case Management/ Utilization Management team.
* Coordinate, under direction of the nurse Case Manager/Social Worker and in collaboration with the healthcare team, patient care transitions which may include faxing information, arranging authorization and transportation, confirming arrangements, obtaining clothing, durable medical equipment etc.
* Support comprehensive coordination of medical services including intake, screening and supporting the implementation of care plans to promote effective utilization of healthcare services.
* May assist in providing transportation as directed.
* Participate in staff meetings, training and/or in-services and on-going educational groups.
* Contribute to documentation of coordinated functions in appropriate computer systems and the patient's electronic medical record.

Requirements:

* Education - High School Diploma/GED Equivalent in General Studies
* Preferred: Certification - State drivers license; Certified Nurse Aide (CNA) - South Dakota Board of Nursing
* Experience - 1+ years of Clerical Experience; 1+ years of Medical Terminology Experience

Physical Requirements:

Sedentary work involves sitting most of the time.

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