Care Management Resource Coordinator

7 days ago


Phoenix, Arizona, United States Phoenix Children's Hospital Full time
Job Summary

We are seeking a highly skilled Care Management Resource Coordinator to support the efforts of our Social Work, Case Management, and Utilization Management teams. This role will play a critical part in promoting a positive patient-family experience during hospitalization, facilitating safe and timely discharge of patients, and reducing risk of unfunded services or excessive cost to patients-families.

Key Responsibilities
  • Support Social Work Activities
    • Receive, evaluate, and fulfill requests for local transportation vouchers, meal cards, and other amenities.
    • Receive, evaluate, and fulfill requests for out-of-area transportation, including air travel and lodging.
    • Receive, evaluate, and facilitate requests for Ronald McDonald House services.
    • Escalate requests that do not meet criteria to responsible social worker or manager.
    • Fax medical records and other documents to law enforcement agencies, government agencies, and other healthcare organizations.
    • Assist patients-families to schedule appointments with various agencies.
    • Assist patients with documents or letters needed for FMLA, border crossing applications, school activity letters, and other social needs related to their care.
    • Schedule care conferences.
    • Maintain complete and accurate patient resource materials, including primary care providers by payer source, WIC information, housing resources, and other social services.
  • Support Utilization Management Activities
    • Review and organize materials faxed to department, prepare daily reports, and distribute/direct to appropriate Utilization Management nurse.
    • Receive and review third-party payer requests for concurrent review and notifications of denied hospital days; route to appropriate Utilization Management nurse.
    • Answer Utilization Management/Case Management phone line and retrieve voice mail messages.
    • Scan and upload into the EMR and/or financial applications authorization and requests for concurrent and retrospective third-party utilization reviews.
    • Enter authorization information in financial applications.
    • Maintain reports of denied hospitalizations and hospital days, pending appeals, outcomes of appeals, and reasons for delayed discharges.
  • Support Case Management Activities
    • Identify and provide appeal rights letters to in-house Tricare and Medicare patients, and document in log and the medical record.
    • Verify address and other demographic information for purposes of coordinating delivery of home needs and communication with families post-discharge.
    • Identify current home care service providers, and document in the medical record for the Case Manager.
    • Determine third-party payer coverage/benefits and obtain insurance pre-authorization for home health services, post-discharge medications, rehabilitative therapy, durable medical equipment, medical transportation, and other post-discharge needs.
    • Facilitate arrangements for post-discharge needs, including scheduling services and coordinating availability of equipment/supplies and medications, under the direction of the Case Manager.
  • Care Management Department Support
    • Understand and focus on Hospital Revenue Cycle key performance indicators.
    • Work collaboratively with team members and perform clerical cross-coverage where needed.
  • Customer Service
    • Respond to emails within 24 hours.
    • Clear communication skills with all internal and external customers.
    • Provide excellent service routinely in interactions with all customers.
  • Miscellaneous Job-Related Duties
    • Perform miscellaneous job-related duties as requested.


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