Care Management Specialist

Essential Functions

• Affords support to the Care Management team in coordinating discharge planning, referrals, and follow-up services to support patients' post-hospital care.
• Communicates with insurance providers, payers, and authorization departments to verify coverage and obtain necessary approvals for care services.
• Maintains accurate documentation of care management activities, ensuring timely entry of notes, referrals, and authorizations into the electronic medical record (EMR).
• Supports patient and family communication, providing general information about discharge instructions, community resources, and follow-up appointments.
• Collaborates with home health agencies, durable medical equipment (DME) providers, skilled nursing facilities, and other post-acute care services to facilitate smooth care transitions.
• Reviews and organizes patient charts, medical records, and required forms to ensure all necessary information is available for care management staff.
• Tracks and follows up on pending authorizations, service requests, and post-discharge care needs, escalating concerns to Care Managers as needed.
• Affords support with patient screenings and assessments, ensuring compliance with regulatory guidelines and hospital policies.
• Incorporates age-specific considerations in discharge planning, ensuring patient needs are met appropriately based on developmental and medical factors.
• Supports compliance with CMS, Joint Commission, and other regulatory requirements by maintaining organized and complete documentation.

Qualifications

• 1-2 years of experience in care coordination, case management support, patient access, or healthcare administration required.
• Experience in a hospital, insurance, or post-acute care setting with knowledge of healthcare payers and authorizations preferred.
• Knowledge of care management processes, discharge planning, and post-acute care coordination.
• Familiarity with insurance verification, prior authorizations, and healthcare payer requirements.
• Proficiency in electronic medical records (EMR) systems and healthcare documentation practices.
• Strong organizational and time management skills, with the ability to prioritize multiple tasks.
• Excellent communication and interpersonal skills, ensuring effective collaboration with patients, families, and healthcare providers.
• Ability to problem-solve and work independently, escalating complex issues to the appropriate Care Management team members.
• Understanding of HIPAA regulations and patient confidentiality standards.