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Case Manager
2 months ago
As a Case Manager at SSM Health, you will play a vital role in coordinating systems and services with a trans-disciplinary team approach to deliver quality, cost-efficient care to patients throughout the continuum of healthcare services.
Key Responsibilities:- Assess and Coordinate Care: Assess data to determine medical necessity and appropriateness of level of care/admission based on approved criteria, and complete insurance verification and authorizations for specific patient populations from preadmission through discharge.
- Manage Patient Benefits: Manage patient benefits by checking insurance eligibility to optimize payment of services rendered for alternative cost-effective levels of care, and notify physician, business office, and patient/family of insurance denials.
- Collaborate with Healthcare Team: Attend weekly treatment team meetings with physicians, therapists, and nursing staff to discuss treatment options, benefits, insurance authorizations, and discharge planning.
- Collect and Maintain Clinical Information: Collect, record, and maintain clinical information gathered from concurrent or retrospective review and assess for medical necessity criteria.
- Conduct Admission and Stay Reviews: Conduct appropriateness of admission and continued stay reviews concurrently or retrospectively.
- Improve Case Management Processes: Work effectively with internal and external customers and proactively improve case management processes.
- Education: Bachelor's degree in Mental Health or related field.
- Experience: Three years' experience.
This role is a Day Shift position with a scheduled weekly hours of 40. SSM Health is an equal opportunity employer and values diversity in the workplace.
