JOB SUMMARY:

Under the supervision of the Lead Case Manager, or Director of Quality, this role completes various duties to enhance the efficiency of the Case Management Department, as well as support the daily functions of the case managers. This role assists in securing arrangements for the discharge transition and post-acute services. While monitoring the revenue cycle process related to insurance certifications, insurance verification, peer-to-peer completion, and denial/appeal tracking, this position serves as a liaison between the Case Management Department, payers, and additional entities.

ESSENTIAL FUNCTIONS:

• Provides assistance to the case management staff, including but not limited to, creating and sending referral packets, organizing admission and discharge patient records, making phone calls, obtaining signatures, or any other assistance needed determined by the CM team.
• Assists the case management team in scheduling family conferences.
• Assists the case management team by making necessary arrangements for post-discharge follow up care.
• Functions as the point of contact and liaison for the hospital Case Management Department staff regarding clinical insurance review completion and/or issues.
• Forwards the necessary patient clinical information for all admission, concurrent, and retrospective insurance reviews to payers for the completion of medical necessity reviews.
• Monitors, follow-up, documents, and tracks payer responses/requests of completed clinical reviews, including approvals, appeals, and denials, and communicates these to the appropriate personnel [hospital staff, physician, DCM, Case Manager, Clinical Denial Management, and Centralized Business Office (CBO)].
• Monitors and tracks the total hospital certified days of the patient for payers (commercial, managed care, and Medicaid) and communicates missing certifications to the Lead CM/DQ and Case Manager.
• Organizes and prepares the necessary clerical elements for the weekly Interdisciplinary Team Meeting to function timely and efficiently.
• Enter DME needs per order sheet specifications.
• Prepare Discharge IMM for delivery.
• Deliver Advance Directive packets.
• Assist with Rehabtracker sign ups.
• Ability to maintain confidentiality of all patient and/or employee information to assure patient and/or employee rights are protected.
• Ability to interface on all levels of the organization by demonstrating excellent interpersonal skills.
• Ability to communicate effectively, both in writing and verbally.
• Ability to work cooperatively and collaboratively as a member of a team.
• Ability to work under stress and to respond quickly in emergency situations.
• Must have good and regular attendance.
• Performs other related duties as assigned.

• College degree in healthcare related field preferred
• LPN or social work degree preferred but not required
• Minimum of 1 year hospital or post-acute healthcare experience with preference in case management or clinical department. Proficient with WORD and EXCEL software, keyboard typing, and general office equipment.