Case Management Specialist; Full-time, MMMC

Case Management Specialist

The Case Management Specialist provides non-clinical support and assistance to the CD Patient Care Cont Care, as assigned. Responsible for providing assistance with the process of conveying information, tracking patients, and coordinating health care services for patient as they transition across various levels of care.

Essential Responsibilities:

• Utilize discharge planning knowledge and skills to coordinate and implement the discharge plan developed by the CD Patient Care Cont Care.
• Document actions according to hospital and department standards.
• Obtain placement availability for post-acute providers and communicate to Care Management team.
• Prepare and transmit referral packets for discharge including but not limited to: Skilled Nursing Facility, Home Health Care Agencies, Hospices, Foster Families, Care Homes, and transfers to higher levels of care.
• Follow-up on referrals to ensure receipt of referral to intended company/facility and ensure all necessary information/documentation was provided.
• Receive and respond to all requests from facilities/companies for pertinent information to acquire approval/placement for patients needs on behalf of Patient Care Coordinators.
• Prepare and transmit referral packet to dialysis centers.
• Notify CD Patient Care Cont Care of all new consults, new discharge/placement orders received.
• Contact insurance companies to acquire authorization for post-acute provider services.
• Verify patient personal information and service address for Home Care post-acute providers.
• Receive authorizations/reference codes from insurance companies via phone and fax. Document and forward to be recorded and scanned appropriately.
• Prepare and transmit necessary documentation/information to facilitate prior authorization of off formulary drugs for home use.
• Assist with gathering and transmitting medical records to the QIO in response to appeals.
• Arrange DME.
• Assist with scheduling post hospitalization follow-up appointments with PCP, specialty physicians and other necessary outpatient services.
• Coordinate and arrange post discharge transportation.
• Valid delivery of beneficiary notifications such as but not limited to the IMM and MOON as directed by the CD Patient Care Cont Care.
• Maintain current knowledge about, understands and follows Federal and State regulations, requirements regarding insurance coverage, case management and the use of specific guidelines and protocols.
• Perform other related duties as directed.

Basic Qualifications:

• Minimum two (2) years of healthcare experience required.

Education

• Associates degree or two (2) years of directly related experience required. High School Diploma or General Education Development (GED) required

Additional Requirements:

• Excellent communications skills.
• Familiar and comfortable with medical terminology.
• Demonstrated knowledge of and skill in word processing, spreadsheet, and database PC applications.

Preferred Qualifications:

• Minimum two (2) years of utilization management experience preferred.
• ICD-9 and CPT coding preferred.