Care Management Coordinator

Cleveland Clinic

1d•Remote

About The Position

At Cleveland Clinic Health System, we believe in a better future for healthcare. And each of us is responsible for honoring our commitment to excellence, pushing the boundaries and transforming the patient experience, every day. We all have the power to help, heal and change lives — beginning with our own. That’s the power of the Cleveland Clinic Health System team, and The Power of Every One. Join the Cleveland Clinic team, where you will work alongside passionate caregivers and provide patient-first healthcare. Cleveland Clinic is recognized as one of the top hospitals in the nation. At Cleveland Clinic, you will receive endless support and appreciation and build a rewarding career with one of the most respected healthcare organizations in the world. As a Care Management Coordinator, you will support the organization and team through monitoring compliance with assigned responsibilities as well as completing daily and weekly tasks and coordinating with patient financial services. Your work will help ensure timely discharges to post-acute facilities and discharge coordination. This role will allow you to expand your knowledge of insurance authorizations as well as potentially move into a supervisor opportunity. Come take this opportunity to work for Cleveland Clinic with a dynamic team of like-minded professionals. This is a regular PRN position, with caregivers working days between 8:00 a.m. -- 4:30 p.m. with weekend requirements. Cleveland Clinic is a nonprofit multispecialty academic medical center that integrates clinical and hospital care with research and education. Headquartered in Cleveland, Ohio, it was founded in 1921 by four renowned physicians with a vision of providing outstanding patient care based upon the principles of cooperation, compassion and innovation. Cleveland Clinic has pioneered many medical breakthroughs, including coronary artery bypass surgery and the first face transplant in the United States. U.S. News & World Report consistently names Cleveland Clinic as one of the nation’s best hospitals in its annual “America’s Best Hospitals” survey. Among Cleveland Clinic’s 70,800 employees worldwide represent 140 medical specialties and subspecialties. Cleveland Clinic is a 6,500-bed health system that includes a 173-acre main campus near downtown Cleveland, 19 hospitals, more than 220 outpatient facilities, and locations in southeast Florida; Las Vegas, Nevada; Toronto, Canada; Abu Dhabi, UAE; and London, England.

Requirements

Knowledge of financial and utilization review software, including ECIN, InterQual and Kepro
Two years of hospital care management experience

Responsibilities

Facilitate efficient Care Management services.
Monitor compliance with assigned responsibilities, complete daily/weekly tasks and coordinate with patient financial services.
Conduct InterQual initial and continued stay reviews, initial and continued stay clinical authorization and 7- and 10-day LOS clinical and financial justifications.
Ensure coverage for 24/7 on-call process and weekend coverage.
Conduct daily analysis of reports on observation status reviews, daily comparison of anticipated discharges to actual discharges by IM team and attending physician and weekly analysis of assigned tasks of each case manager to ensure completion of Allscripts/ECIN documentation necessary for clinical LOC justification and payer reimbursement.
Distribute results of reports on the efficiency and completion of Care Management activities with staff for staff input, follow-up and feedback.
Ensure InterQual and Allscripts/ECIN reports are distributed to each staff member for action to address identified issues.
Provide daily/weekly reports to the Director of Clinical Process and Risk Management regarding actions taken to assure full compliance with staff performance expectations.
Coordinate authorizations, initial and concurrent clinical reviews, submission of data to payers and status of Kepro data entry with all assigned case managers.
Ensure that both Care Management and Patient Financial Staff have documented authorizations in both Allscripts/ECIN and Invision to ensure Hospital payment for care provided.
Ensure unit/department is staffed to provide adequate coverage appropriate to meet service needs.
Maintain departmental files to assure competency with all assigned tasks and compliance with applicable regulations and standards.
Ensure compliance with CMS/Medicare regulations.
Conduct daily assessments of patient caseloads and assign/reassign staff as needed to ensure patient needs are met.
Provide staff training as needed on the access and use of all IT programs including Invision, Allscripts/ECIN, Epic and KEPRO.
Maintain departmental files to ensure competency with all assigned tasks and compliance with applicable regulations and standards.
Maintain confidentiality and ensure compliance with CMS/Medicare regulations.
Document, circulate and maintain minutes of staff meetings.
Complete bi-weekly payroll and payroll variance reports as required.