Case Management Coordinator

Astrana Health, Inc.•Houston, TX

37d•$19 - $25•Hybrid

About The Position

Assist Case Manager(s), Specialist, Supervisor & Manager in assigned area of responsibility, including compiling information (open & close inpatient cases), fax authorization letters to providers, including sending denial letters and keeping records. Provide and coordinate information with outside agencies.

Requirements

High School Graduate or equivalent
A minimum of 2 year experienced in managed care environment to include but not limited to an IPA or MSO preferred
Knowledge of medical terminology, RVS, CPT, HPCS, ICD-9 codes
Proficient with Microsoft applications’ and EZCAP
Good organizational skills
Good verbal and written communication skills
Must have the ability to multitask and problem solve in a fast pace work environment
Punctuality, precision with details, creativity, etc. would be helpful for this position
Ability to follow directions and perform work independently according to department standards
Able to function effectively under time constraint
Able to maintain confidentiality at all times
Willingness to accept responsibility and desire to learn new task
Ability to comply and follow company policies and procedures
Must be a strong team player, punctual and have excellent attendance record

Responsibilities

Comply with CM policies and procedures. Annual review of selected CM policies
Provide support to case managers on day-to-day activities
Sort, stamp and distribute incoming faxes
Create authorization/tracking numbers for all discharge planning admissions
Obtain in-patient discharge orders, clinical documents and follow-up discharge plan dates
Communicate with Hospitals, SNF, Acute Rehab & other admitting facilities on status/updated discharge plan
Provide authorization(s) for services requested on discharge (i.e., DME, Home Health, others)
Update authorization notes to include the status of tracking number
Notify admitting facility case management team & medical group case manager(s) all discharge needs of patient(s) status
Assist in researching problems that occurs in case management department in a timely fashion
Responsible for follow-up and returning department calls
File and scan hospital records as assigned
Report to CM Lead 3, supervisor & manager on activities or problems occurring throughout the day
Attend to provider and interdepartmental calls in accordance with exceptional customer service
Demonstrate professional responsibility in the role of Discharge Planner
Coordinating/Managing all discharges from In Patient and SNF. Handles at least 15-40 discharges a day
Arranging/Coordinating all D/C plan to Home Health, Hospice, IV and DME
Follow up call to Home Health admitted on a weekends
Creating/approving Authorizations/ cases for Home Health, Hospice, DME and IV
Responsible for reviewing TARS 30-70 a day (Treatment Authorization Request) and approving it
Doing on-call after office hours/weekends when needed a coverage
Other duties as assigned