Job Description
Responsible for assisting with the continuum of care: performing tasks identified by the case management team for discharge planning, utilization management, and care coordination support.
Principal Accountabilities:
- As assigned, provide support to the RN Case Managers and Social Workers in completing routine post-acute care arrangements. This includes setting up routine post-acute services according to MD orders.
- Completes tasks related to transfer of patients to post-acute care facilities including:
a. Communication with facility related to bed availability, including use of case management electronic discharge system.
b. Sharing of internal referral information electronically or via fax
c. Assuring transfer of documentation/medical record complete
d. Arranging transportation, confirmation of arrangements, and communication with families regrading transfer arrangements
e. Maintaining and managing authorizations of post-acute settings, such as skilled nursing facilities, home care agencies, infusion service, durable medical equipment services, hospice, acute rehab, and long-term acute care facilities.
f. Demonstrating independence and proactive initiation of duties related to transfer of patients described above
- Assist the department in maintaining authorization or overcoming coverage denials by payers by providing medical records as demanded or required.
- Arrange medical transportation where required, including receiving insurance or medical group authorization.
- Prepare and fax necessary documentation/information to facilitate prior authorization
- Follow up on the above referrals by phone to ensure receipt of referral to intended company/facility and ensure all necessary information/documentation was provided. Receive and document authorizations requested.
- Secures requested information for the healthcare team, patient, and/or family. This could include prescription availability, insurance requirements, and community resources
- Uses case management electronic system to support case management, utilization management and discharge planning process, as directed
- Supports the case management staff in tasks related to care coordination, discharge planning, and/or utilization management
- Assist with data collection
- Keeps team members updated with progress of assigned tasks. Escalates issues to case manager, social worker or leadership staff in a timely manner.
- Documents accurately and thoroughly all transactions during the shift, according to department policy.
Required:
- High School diploma or GED equivalent
- Minimum two years' experience with a medical group, managed care organization, utilization management, hospital admitting, or medical nursing unit
Preferred:
- Associate degree preferred
- Hospital and/or insurance experience preferred.