Case Management Assistant - Case Management (8:00 am - 4:30 pm)

About the role

The Case Management Assistant provides support services to Care Coordinators and Social Workers with transition planning activities, including scheduling discharge appointments, clerical tasks, arranging post-acute care, documenting interactions, utilization management support, and collaborating with various departments.

Responsibilities

• Schedule discharge appointments for primary care specialists or clinics
• Perform clerical activities as needed
• Collaborate with patients, families, and health care team to ensure safe and effective transition through continuum of care
• Arrange post-acute care services under direction of Care Coordinators/Social Workers and physician orders
• Document all interactions with patients/families per departmental and regulatory standards
• Provide utilization management support for the utilization review process
• Work collaboratively with Utilization Management, Patient and Provider Services, Claims Department, and Care Coordination Department staff
• Assist in identifying, tracking, and coordinating services for patients
• Locate appropriate facilities (skilled nursing, long-term acute care, acute rehab) and communicate bed availability to case management team
• Assist patients with Durable Medical Equipment (DME) as needed to meet home care needs per physician order and payer requirements
• Contact insurance companies/medical groups to obtain authorization for post-acute services when applicable
• Obtain required signatures on Medicare IM prior to discharge
• Verify member eligibility before processing authorizations
• Assist in verifying health plan benefits and coordinating ambulatory services
• Coordinate and facilitate discharge arrangements according to hospital policies, state and federal rules
• Interface with physicians and outside reviewers to request appropriate orders and authorization for necessary post-acute services
• Document all discharge arrangements in the electronic medical record flow sheet under the appropriate care management navigator
• Identify involvement of patient/family/caregivers in planning process and involve them in formation of plan of care and discharge needs
• Work cooperatively and respectfully with patients/families and interdisciplinary teams in discharge planning
• Function as a patient advocate
• Enter data and process referral authorization requests, including appropriate coding and quantities
• Answer incoming calls from providers, IPAs, medical groups, and other internal/external calls; assist on queues as needed
• Monitor the Fax Inbox and appropriately distribute incoming faxes
• Ensure internal compliance security measures are met
• Contact facilities identified by UM Nurses/Manager/Director/Medical Director to research issues (contract, discharges, services provided)
• Identify non-contracted providers and request Letters-of-Agreement when requested
• Request support documentation from IPAs/Medical Groups as requested by UM Nurses, Medical Directors, or Management
• Document all patient-specific information in appropriate information systems
• Process extensions and denial letters when needed
• Prepare Utilization Review Reports as necessary
• Provide assistance to the Claims Department when requested
• Assist Case/Care Managers in coordinating and arranging services for members

Requirements

• 1 year Healthcare experience with general knowledge of medical terminology
• Must complete a medical terminology course within 12 months of hire
• Familiarity with community resources and social supports (required)
• 1 year Experience in an acute care hospital; skilled nursing facility, home health/hospice setting or medical office setting (required)

Qualifications

• High School Diploma/GED – required
• Associate’s Degree/College Diploma in Business or Healthcare field – preferred
• 1 year Case Management/Social Work support role – preferred
• 1 year Working in an acute care facility – preferred
• 1 year Previous utilization management or managed care experience – preferred
• Word processing and spreadsheet skills – preferred