Integrated Case Management Specialist

About the role

Our team members are the heart of what makes us better. At Hackensack Meridian Health we help our patients live better, healthier lives — and we help one another to succeed. With a culture rooted in connection and collaboration, our employees are team members. Here, competitive benefits are just the beginning. It’s also about how we support one another and how we show up for our community. Together, we keep getting better - advancing our mission to transform healthcare and serve as a leader of positive change.

Responsibilities

• Performs selected services and functions related to insurance management with various payors, ortho calls, payer communications and support of the Care Coordinators.
• Prepares required Appeals and Denial information for processing and follows up on receipt of communication including Livanta appeal management process.
• Oversees the sorting and distribution of mail in the department.
• Answers case management and social work phones.
• Handles Medicaid appointment, all discharge functions for the Care Coordinators, including seventy hour discharge report and providing patients with the IM Letter from Medicare prior to discharge.
• In collaboration with the Care Coordinator, reviews daily admission data to verify inpatient insurance coverage, pre-certs, authorized days, and reviews needed; alerts the CC to potential problems.
• If authorization/precert information is missing or incorrect, contacts admitting to obtain necessary and accurate information.
• Performs daily log reconciliation.
• Utilizes EPIC computer software to retrieve necessary information, inclusive of free text fields, to support the case management, utilization review process.
• Retrieves information for the Physician Advisors as needed.
• Works the DNFB report to determine outlier days, approved