Discharge Planner - Case Mgmt

Conifer Health Solutions•San Antonio, TX

About The Position

Description This position may qualify for a sign-on bonus. POSITION SUMMARY The individual in this position works under the direction of the RN and/or Social Worker to complete referrals for post-acute services for patients, and assists with tasks that do not require a clinical license or degree. The individual’s responsibilities include the following activities: a) arrange post-discharge services; b) create and follow up on electronic referrals using the Tenet Case Management system; c) review patient choice letters with patients/families for required signatures; d) provide follow up Important Message to Medicare patients prior to discharge; e) communicate with patients, families and other members of the care team; f) complete tasks assigned by Case Manager and Social Work staff; g) make copies, send faxes and complete phone calls; h) complete process reviews or audits as requested; and i) other duties as assigned. Responsibilities General Functions: Utilization Management  Validates patient’s demographic and payer information with patient/family and notifies Patient Access immediately if any corrections are needed within 24 hours of admission  Validates that all commercial/managed care discharge have an authorization for status and level of care provided and notifies Director of Case Management (DCM) or designee of variances  Escalates discharged cases at end of the day that have no authorization or notification or dispute is provided by payor.  Ensures, on a concurrent basis, that all clinical needed by payors and updates are provided by 100% alerting Case Manager assigned to case and escalating to DCM if not complete timely  Trends dispute/denial potential to DCM or designee by failure points to revenue cycle  Prepares denial information for UR Committee, Denial and Revenue Cycle Meetings  Collaborates with Patient Access, Case Management, Managed Care and Business office to improve concurrent review process to avoid denial or process delays in billing accounts. Transition Management  Follows up on Authorization for post-acute services  Makes referrals for post-acute services under the direction of the RN Case Manager or Social (SW) staff utilizing the Tenet Case Management documentation system..  Follows-up if referral requires authorization by payor to discharge the patient  Completes tasks as assigned by RN or LVN Case Manager and/or SW staff  Makes copies, sends faxes and complete phone calls to arrange post-acute services and to ensure that appropriate hospital information is communicated to post-acute serviced and to ensure that appropriate hospital information is communicated to post- acute providers  Documents all referrals and tasks in the Tenet Case Management documentation system per Tenet policy  Provides Important Message follow-up letters to Medicare beneficiaries per Tenet policy and under the direction of the RN Case Manager or SW Compliance  Adheres to federal, state, and local regulations and accreditation requirements impacting case management scope of services  Adheres to department structure and staffing ,policies and procedures to comply with the CMS Conditions of Participation and BHS/Tenet policies Other:  Utilizes resources efficiently and effectively  Maintains safe environment  Participates in Performance Improvement activities

Requirements

MINIMUM EDUCATION: High School diploma or equivalent
MINIMUM EXPERIENCE: 2 years of experience in clerical or healthcare field.
Possesses excellent organizational, verbal/ written communication skills, problems solving and computer literacy skills.
Data Analytics skills.

Nice To Haves

PREFERRED EDUCATION: Associate’s or Bachelor’s Degree from an accredited college
PREFERRED EXPERIENCE: Acute hospital experience
PREFERRED CERTIFICATIONS/LICENSURE: Paramedic, EMT or Nursing Assistant certifications.

Responsibilities

arrange post-discharge services
create and follow up on electronic referrals using the Tenet Case Management system
review patient choice letters with patients/families for required signatures
provide follow up Important Message to Medicare patients prior to discharge
communicate with patients, families and other members of the care team
complete tasks assigned by Case Manager and Social Work staff
make copies, send faxes and complete phone calls
complete process reviews or audits as requested
other duties as assigned
Validates patient’s demographic and payer information with patient/family and notifies Patient Access immediately if any corrections are needed within 24 hours of admission
Validates that all commercial/managed care discharge have an authorization for status and level of care provided and notifies Director of Case Management (DCM) or designee of variances
Escalates discharged cases at end of the day that have no authorization or notification or dispute is provided by payor.
Ensures, on a concurrent basis, that all clinical needed by payors and updates are provided by 100% alerting Case Manager assigned to case and escalating to DCM if not complete timely
Trends dispute/denial potential to DCM or designee by failure points to revenue cycle
Prepares denial information for UR Committee, Denial and Revenue Cycle Meetings
Collaborates with Patient Access, Case Management, Managed Care and Business office to improve concurrent review process to avoid denial or process delays in billing accounts.
Follows up on Authorization for post-acute services
Makes referrals for post-acute services under the direction of the RN Case Manager or Social (SW) staff utilizing the Tenet Case Management documentation system.
Follows-up if referral requires authorization by payor to discharge the patient
Completes tasks as assigned by RN or LVN Case Manager and/or SW staff
Makes copies, sends faxes and complete phone calls to arrange post-acute services and to ensure that appropriate hospital information is communicated to post-acute serviced and to ensure that appropriate hospital information is communicated to post- acute providers
Documents all referrals and tasks in the Tenet Case Management documentation system per Tenet policy
Provides Important Message follow-up letters to Medicare beneficiaries per Tenet policy and under the direction of the RN Case Manager or SW
Adheres to federal, state, and local regulations and accreditation requirements impacting case management scope of services
Adheres to department structure and staffing ,policies and procedures to comply with the CMS Conditions of Participation and BHS/Tenet policies
Utilizes resources efficiently and effectively
Maintains safe environment
Participates in Performance Improvement activities