Case Manager Assistant - Full Time - Days
About The Position
Under the leadership of the Director of Case Management, the Case Manager Assistant will function as an active member of the CM/ Utilization Review team. In their role, they will be assessing, preparing, and assisting patients in meeting their social needs in addition to the discharge process, as needed. The Case Manager Assistant will deliver professional services consistent with the strategic vision, goals, philosophy, and direction of the Utilization Review Department and Crisp Regional Hospital. This role provides ongoing support and expertise to ensure that multiple services needed by the patient upon discharge are met. The Social Worker Discharge Planner monitors services delivered to selected patient populations during the acute hospital stay and promotes effective utilization of resources.
Requirements
- Requires a Licensed Practice Nurse
- Requires and maintains current state license as a Licensed Practical Nurse
Nice To Haves
- Three to five years varied acute care experience or comparable job-related experience
- Basic understanding of Medicare/Medicaid, Commercial insurance and regulatory guidelines
- Experience in social services, discharge planning, utilization management or care coordination
Responsibilities
- Assist in conducting assessments and developing safe discharge disposition
- Coordinate and collaborate with interdisciplinary teams, community agencies, patients, and families to ensure timely, safe, and effective discharge planning
- Participate in discharge planning and care transitions to post-acute settings as applicable to ensure plans align with clinical goals, patient preferences, and payer requirements
- Coordinate services across acute, post-acute, and community settings
- Arrange community services, durable medical equipment, transportation, and follow-up care
- Provides referrals as indicated to the appropriate health care team member and/or post-acute service
- Follow up on receipt of referrals
- Verify patient’s insurance information, report any discrepancies and follow up as required
- Obtains authorization number for new admissions when needed, documents number of days approved, next review date and level of care in the department utilization review documentation tool
- Coordinate and submit timely clinical reviews to payers
- Enter denials, assist in setting up peer to peer reviews and obtaining outcomes
- Assist in providing Choice, IMM and MOON forms
- Review clinical documentation to determine medical necessity and appropriate level of care using approved criteria (e.g., InterQual®, MCG®)
- Conduct admission, continued stay, and concurrent reviews
- Ensure timely conversion between observation and inpatient status when indicated
- Assist with prevention of avoidable delays, extended length of stay, and readmissions
- Assist in entering documentation for rationale
- Support RN, UR and SW in obtaining patients forms in Cerner
- Documentation of all interventions per hospital/departmental policies
- Perform general clerical duties such as answering the phone, checking voicemail
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
Number of Employees
251-500 employees
