Care Management Coordinator

Cleveland Clinic

1d•Remote

About The Position

This role is remote to Florida residents only. As a Care Management Coordinator for the Regional Resource team at Cleveland Clinic, you will support the organization and team by monitoring compliance with assigned responsibilities, completing daily and weekly tasks, and coordinating with patient financial services. Your primary goal will be to ensure timely discharges to post-acute facilities and facilitate discharge coordination. This position offers an opportunity to expand knowledge of insurance authorizations and potentially lead to a supervisor role. You will work remotely from 8:00 a.m. to 4:30 p.m. with rotating Saturday requirements.

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 ensure 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 for 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.