About the position
As a Care Management Assistant, you support the care management team with the utilization review process such as intake, transmission, and tracking of clinical reviews to payors, coordination of post hospital care and service arrangements, and ensuring that documentation, communication and information required to facilitate patient discharge is complete. You understand that it's not just “paperwork”. What you do is a vital connection that facilitates and readies patients for the next phase of their healthcare journey. That's why you put a little “extra” heart into everything you do. We love that about you. Your experiences, knowledge, skills, empathy, compassion, and your “little something extra” all add up to you. And we're excited to get to know you and find out what you'll bring to this care management support role.
Responsibilities
- Participate in discharge planning activities as needed to ensure appropriate referrals to post-acute providers and timely patient discharges.
- Assist in the research for available preferred providers for post-acute care to meet the patient's needs for discharge.
- Contact post-acute care providers and transmit information needed for the referral process and provide follow-up to ensure identification and communication of available resources.
- Collect, copy, and transmit pertinent patient demographic and clinical information required to complete arrangements for post-acute care and/or placement.
- Transmit transition of care documents to primary care physician and post-acute providers.
- Facilitate timely transmission of reviews to the payers in coordination with the case management team.
- Communicate pertinent information received from payers to relevant stakeholders.
- Support and assist with concurrent insurance denials and appeals processes and provide denial and non-certified day information to the appropriate stakeholders to reduce potential denials.
- Collaborate with other departments to ensure accuracy of patient and payer information.
- Assist the department leadership in data management.
- Maintain accurate payer contact information and update in software system to ensure accuracy in review submission.
- Validate and update vendor information.
Requirements
- High school diploma/GED and 2 years of office/clerical experience in a healthcare setting.
- 4 years of experience in a healthcare setting is required in lieu of education.
