Case Management Coordinator

$46,987 - $68,536/Yr

ScionHealth - Rancho Cucamonga, CA

Full-time

Rancho Cucamonga, CA

Hospitals

About the position

The position involves supporting the Case Management Department in a specialty hospital setting, focusing on enhancing efficiency and facilitating the discharge transition for patients. The role includes assisting Case Managers with various tasks, such as insurance verifications, scheduling, and communication with payers and post-acute providers, under the supervision of the Director of Case Management.

Responsibilities

• Assist Case Management staff by creating and sending referral packets.
• Organize admission and discharge patient records.
• Make phone calls and obtain necessary signatures.
• Schedule family conferences as needed.
• Arrange post-discharge follow-up care for patients.
• Serve as a liaison for the Case Management department regarding clinical insurance reviews.
• Forward patient clinical information for insurance reviews to payers.
• Monitor and track payer responses to clinical reviews, including approvals and denials.
• Track total hospital certified days for patients and communicate missing certifications.
• Initiate and complete insurance pre-certifications for patients.
• Communicate pre-authorization outcomes to relevant individuals.
• Organize clerical elements for Case Management meetings.

Requirements

• Must read, write, and speak fluent English.
• Ability to learn logistics of insurance verification and certification processes.
• Clinical knowledge to interpret medical records and identify treatment plans.
• Knowledge of Medicare benefits and insurance processes.
• Familiarity with accreditation standards and compliance requirements.
• Excellent interpersonal, verbal, and written communication skills.
• Ability to work under stress and multitask effectively.

Nice-to-haves

• College degree in a healthcare-related field preferred.
• 1 year of experience in a healthcare setting.