Care Management Tech

DMC Sinai-Grace Hospital is committed to providing exceptional patient care in a supportive and collaborative environment. As a member of our team, you will have the opportunity to work with advanced technology and be part of a healthcare community dedicated to making a positive impact on the lives of our patients.

Benefits

At Tenet Healthcare, we offer a comprehensive benefit package that prioritizes your health, professional development, and work-life balance. The available plans and programs include:

• Medical, dental, vision, and life insurance
• 401(k) retirement savings plan with employer match
• Generous paid time off (PTO)
• Career development and continuing education opportunities
• Health savings accounts, healthcare and dependent flexible spending accounts
• Employee Assistance program
• Employee discount program
• Voluntary benefits including pet insurance, legal insurance, accident and critical illness insurance, long-term care, elder and childcare, auto and home insurance

Note: Eligibility for benefits may vary by location and is determined by employment status.

About the Role

Under general supervision and according to established policies and procedures, provides assistance to Care Management functions for the site. Participates as a member of the Care Management Team to facilitate process flow in care coordination activities and transition planning.

Responsibilities

• Communicates with Third Party payers and other community resources to assist in the patient disposition process.
• Interfaces with Patient Financial Services on issues related to eligibility, benefit coverage, and appropriate provider.
• Performs input into various databases as appropriate for utilization management, LOS management, and Denial Management activities.
• Audits data input and corrects errors, as needed.
• Investigates and responds to inquiries related to the authorization process, benefit coverage, and general concerns regarding policies and procedures.
• Maintains necessary utilization review files for all patients in the hospital.
• Validates discharge dispositions and assists with issuing Medicare Important Message letters prior to discharge.
• Establishes and maintains effective relationships with physicians and all other staff members, internally and externally.
• Identifies problems or any dissatisfaction experienced by any customer or referring source and works to resolve them to a high degree of service excellence.
• Uses positive interpersonal skills to effectively resolve conflict.
• Promotes a positive customer relations environment.
• Performs related clerical/secretarial duties as needed.

Requirements

• High school diploma or equivalent.
• One to two years related experience in an outpatient clinic or hospital setting, including six to twelve months of data entry experience.
• One to two years work experience in an insurance, medical records, billing, or related area desirable.
• Medical Assistant certification, license to practice as a Licensed Practical Nurse (LPN), or college coursework in healthcare preferred.
• Additional training in computer applications preferred.
• Working knowledge of medical terminology desired.

Skills

• Interpersonal skills to effectively communicate with third-party payers, hospital staff, and various other internal/external contacts, and to answer telephone inquiries.
• Written and oral communication skills.
• Knowledge of managed care and referral processes.
• Manual dexterity to type and enter data using the computer.
• Ability to utilize computer systems; computer skills and knowledge of various software packages.
• Ability to push, pull, and/or lift objects weighing up to 20 lbs.
• Ability to understand and apply various third-party payer requirements, verification procedures, and benefits.
• Ability to work within a complex environment and handle multiple priorities.
• Mathematical ability to perform basic calculations such as percentages, addition, multiplication, etc.

Facility Description

DMC Sinai-Grace Hospital is an international leader in pediatric and adolescent medicine. Surgical services include general, thoracic, reconstructive, and cardiovascular. Imaging technology designed specifically for children provides advanced diagnostic services including Positron Emission Tomography (PET) and MRI. The Children’s Hospital of Michigan Emergency Department is a verified Level 1 Pediatric Trauma Center and dedicated pediatric burn center. Experts in pediatric critical care, rehabilitation, and neonatal and perinatal medicine provide care for thousands of children every year at Children’s Hospital of Michigan, Children’s Hospital of Michigan - Troy, and six ambulatory sites.

Job Type: Full Time
Shift Type: Day