Status:  Full Time

Shift:     Days with rotating weekend/holiday coverage

Exempt: No 

Summary:

The Case Management Assistant will work collaboratively with the healthcare team, under the direction of the RN Case Managers, Social Workers, and Utilization Review Nurses to assist with the continuum of care, discharge planning, and authorization for hospital services.

Other information:

FACTORS RELATING TO THE JOB

A. Experience, Knowledge and Skill

1. Previous Experience Preferred:

Clerical experience or customer service experience is preferred.

2. Specialized or Technical Education Required:

Required: High school graduate or equivalent

Preferred: Medical Assistant training.

3. Manual or Physical Skill Required:

None

4. Physical Effort Required:

Strength: Sedentary

Push: occasionally

Pull: occasionally

Carry: occasionally

Lift: occasionally

Sit: frequently

Stand: frequently

Walk: frequently

Responsibilities:

Under the direction of the RN Case Manager and/or Social Worker:

1. Prepare and fax referral packets for post-acute care and any home medications with necessary documentation/information to appropriate company/facility.
2. Follow up on referrals by phone to ensure receipt of referral to intended company/facility and ensure all necessary information/documentation was provided.
3. Receive and respond to all fax/phone requests from facilities/companies and provide pertinent information to acquire approval/placement for patient’s needs.
4. Contact insurance company for patients to acquire authorization and preferred placement/DME/transport information.
5. Verify patient personal information at bedside as needed for discharge needs.
6. Document all steps/conversations/information obtained, with patient/patient family members/facilities/agencies throughout the process of consult and placement/arrangement of needs in the medical record.

Under the direction of the Utilization Review Nurse:

1. Communicate clinical review information via fax and/or phone to all third party utilization review companies
2. Maintain and document third-party payer authorizations, contacts, and transactions for individual patients
3. Facilitate the insurance denial appeals process by entering appropriate documentation into patient accounts and Auth/Cert page.
4. Facilitate peer-to-peer reviews and maintain log on Case Management drive.
5. Drop charts through EPIC CareLink to all appropriate payors when requested
6. Prepares and communicates census reports to payer representatives

The Case Management Assistant will also:

1. Notify the RN Case Manager/Social Worker assigned to a patient of new orders for consultation.
2. Update all lists of post-acute providers quarterly and distribute to department staff.
3. Work in conjunction with Program Assistant to ensure medical record requests are provided timely to payer Utilization Review staff.