Case Management Assistant/ Discharge Planner- JNE

Jefferson Health Plans•Philadelphia, PA

1d•Onsite

About The Position

The Discharge Planner/Case Management Assistant facilitates safe, timely, and cost-effective transitions of care by coordinating all post-acute service and appointment needs for patients on the assigned unit. The discharge planner assists the transfer center to ensure timely internal and external transfers. Working collaboratively with providers, care managers, and interdisciplinary team members, the discharge planner ensures that follow-up physician, laboratory, procedural, and financial appointments are accurately scheduled and linked to appropriate orders and payor requirements. This role communicates with third-party payers to secure authorization for inpatient and post-acute services. The Discharge Planner also assesses psychosocial and environmental factors affecting recovery, provides education and referrals to community resources, and supports patients and families in coping with the transition from hospital to home or another level of care.

Requirements

High School Diploma/GED
1 year Computer literate, strong knowledge of medical terminology required.
Knowledge of the techniques and the ability to work with a variety of individuals and groups in a constructive and collaborative manner.
Ability to manage multiple concurrent objectives, projects, groups, or activities, making effective judgments as to prioritizing and time allocation.

Responsibilities

Facilitates safe, timely, and cost-effective transitions of care by coordinating all post-acute service and appointment needs for patients on the assigned unit.
Assists the transfer center to ensure timely internal and external transfers.
Ensures that follow-up physician, laboratory, procedural, and financial appointments are accurately scheduled and linked to appropriate orders and payor requirements.
Communicates with third-party payers to secure authorization for inpatient and post-acute services.
Assesses psychosocial and environmental factors affecting recovery.
Provides education and referrals to community resources.
Supports patients and families in coping with the transition from hospital to home or another level of care.
Provides assistance with the utilization review process, including communicating clinical information/reviews to third party payers to ensure certification/approval of inpatient and post-hospital services.
Assists with the coordination of post hospital care and service arrangements.
Negotiates with payers to obtain authorization for appropriate level of care and length of stay.
Responsible for meeting insurer timeframes regarding review of clinical information.
Provides prompt feedback regarding denials and other payer determinations to the Case Manager RN and Physician Advisor.
Obtain payer authorization and coordinate identified homecare, Durable Medical Equipment (DME), transportation, infusion services and post-acute services for all identified patients.
Interacts with co-workers, visitors, and other staff consistent with the values of Jefferson.
Answers phones in a prompt and courteous manner directing calls and messages to the appropriate individual.
Collaborates with Business Services to ensure accuracy of patient information.
Communicates updated information to all appropriate parties in a timely manner.
Communicates with the Supervisor/CMA colleagues when experiencing capacity to work on additional cases or need assistance.
Communicates with third party payers for verification of insurance benefits/coverage on assigned patients.
Communicates timely, relevant and accurate information to the Case Managers and Social Workers involved in their assigned patients’ care.
Coordinates and arranges transportation, Durable Medical Equipment and community services as directed by the Case Manager or Social Worker.
Documents all approvals, denials, updates and other pertinent information in relevant applications.
Effectively communicates all forms of clinical information to all payers.
Ensures payer and customer satisfaction through effective communication and positive customer service skills at all times.
Ensures utilization management information is submitted to relevant third party payers within the defined timeframes.
Identifies and communicates cases requiring clinical review for the Case Manager, including timeframes for submission of reviews.
Keeps supervisor informed of changes in workload.
Keeps supervisor informed of Third Party Payer patterns and trends.
Maintains confidentiality of patient information.
Maintains routine and frequent communication with Case Managers on the status of their referral requests.
Maintains working knowledge of agency and community resources as required.
Notifies Case Managers of the need for utilization information.
Obtains authorization for appropriate level of care and length of stay from third party payers.
On a daily basis, organizes and creates a priority work list to ensure clinical reviews are completed timely.
Works with Case Managers to prioritize competing requests.
Participates in daily sessions with the Case Manager to ensure key issues are prioritized and addressed that day.
Proactively communicates any change in payer information to Supervisor and Manager of Denial Management and Seamless Access and documents changes appropriately.
Provides updates to the CM/UM Manager, CM or UR Nurse if there are “pending” approvals and additional clinical information is needed for the third party payer to make a determination.
Provides prompt feedback regarding adverse determinations and denials to appropriate staff.
Escalates to the Physician Advisor as necessary as per the Case Manager.
Responsible for meeting insurer timeframes regarding utilization management information.
Acts as a liaison between the van service and the Hospital.
Completes check requests for monthly department invoices.
Directs mail and maintains inventory of supplies.
Maintains resource file; keeps staff informed of changes/updated resource information.
Obtains patient signatures on the Important Message from Medicare within 48 hours of patient discharge.
Screens incoming consults (inpatient or E.R.) and forward to appropriate Case Manager or Social Worker.
When covering the front desk, greet visitors, ascertains the nature of business and refers patients/visitors to the appropriate staff based on established guidelines.

Benefits

medical (including prescription)
supplemental insurance
dental
vision
life and AD&D insurance
short- and long-term disability
flexible spending accounts
retirement plans
tuition assistance
voluntary benefits
tuition discounts at Thomas Jefferson University after one year of full time service or two years of part time service