Care Management Assistant - Case Management

About the role

This position provides technical support to Case Managers and Social Workers to ensure acute care placements, continued length of stay and levels of service are appropriate as provided. Additionally understands denial of services process and works with team members to appeal cases. Assist the care management team to ensure that 100% of admissions are authorized within 24 hours and concurrent reviews are communicated timely.

Responsibilities

• Assist Case Managers with facsimiles to multiple entities, minimal contact with outside entities, and upon approval of patient to contact Case Manager for further instructions
• Develop memorandums or letters to multiple entities
• Utilizes knowledge and expertise to ensure that initial and continued stay clinical reviews are communicated timely to respective payers
• Take initiative to provide pre-admission authorization review to respective payers
• Assist case managers with documentation of Levels of Service based on MS DRG and accepted LOS BENCHMARK
• Provides information to Case Managers timely every morning, noon and mid afternoon regarding inpatient concurrent review
• Takes initiative to obtain clinical form Utilization Review (UR) notes for requested and supplies information to payer
• Retrospective review
• Enters data or collaborates with Case Managers for IS/SI - monitors daily UR notes for needed documentation
• Obtains and enters documentation of required pre-admission approvals/authorizations
• Takes initiative to collect all data to appeal a denial
• Implements appeal process, completes investigations, utilize denial worksheet
• Perform other duties as assigned
• Print reports to be faxed to third party payers
• Runs Milliman Care