Case Management Support Specialist - Case Management

Case Management Support Specialist

The Case Management Support Specialist position is responsible for providing Quality/No Harm, Customer Experience, and Stewardship by ensuring appropriate communication/documentation with third-party payers to receive requests and seek authorization for hospital stays. Provide support with all discharge planning functions within the Case Management department. Be flexible in fulfilling various roles, putting forth the needs of the department. Demonstrate qualities of professionalism, utilizing organizational, communication, and problem-solving skills.

Primary Accountabilities:

1. Gathers information from social workers, utilization review nurses, case managers, or patients to assist in the validation of demographics, insurance information, and facilitation of assigned case management tasks, relating to reimbursement, discharge planning, and regulatory requirements.
2. Ensures proper infection control practices while meeting with patients and families to coordinate discharge plan details in patient care areas.
3. Assists in referral functions which may include sending documents, calling, and producing letters needed to be sent to community providers and/or regulatory agencies.
4. Receives requests and sends clinical information to third-party payers, post-acute agencies/services, and/or regulatory agencies as assigned by Utilization Review Nurses, Case Managers and Social Workers for the purpose of referrals for post-acute care and reimbursement.
5. Completes delegated paperwork required for the execution of the discharge plan and delivery of regulatory forms.
6. Proactively follows up with patients, families, third-party payers, or community agencies, as delegated, to determine needs and provide information to facilitate discharge, reimbursement, or authorization of stay-making documentation.
7. Utilizes various communication methods to relay information and ensure timely receipt and transfer of voice mail messages.
8. Maintains a positive attitude and positive working relationship with patients, families, and all levels within the organization.
9. Documents approved authorization/denial information from payers and provides clear and accurate communication on all accounts to ensure accurate and timely billing.
10. Recognizes and communicate any service delays to the Case Manager, Social Worker and/or Utilization Review Nurse.
11. Utilizes department policies, procedures, and organizational initiatives to proactively complete work assignments, while maintaining the confidentiality of all protected health information.

Work Experience:

Minimum Qualifications:

• Education: High school diploma or equivalent.
• Certification: AHA BLS if the position is hospital based. Not required for remote positions.
• Work Experience: Previous customer service experience working in a face-to-face environment.

• Knowledge/Skills/Abilities:

1. Proficient in Microsoft Office – Outlook, Word, Excel.
2. Ability to work autonomously with minimal supervision.
3. Strong critical thinking skills.
4. Strong communication skills demonstrated both verbally and in writing, with a strong professional presence.
5. Ability to maintain composure in a stressful office environment.
6. Able to work flexible hours and days, including weekends to meet departmental needs.
7. Able to work directly with patients and families in patient care areas and via telephone.

Preferred Qualifications:

• Education: Associate degree.
• Work Experience: Medical, acute care, insurance, or social work experience. One year of customer service experience working in a face-to-face environment.

• Knowledge/Skills/Abilities: Strong organizational skills.

Physical Requirements:

• Majority of time involves sitting or standing; occasional walking, bending, stooping.
• Long periods of computer time or at a workstation.
• Light work that may include lifting or moving objects up to 20 pounds with or without assistance.
• May be exposed to inside environments with varying temperatures, air quality, lighting, and/or low to moderate noise.
• Communicating with others to exchange information.
• Visual acuity and hand-eye coordination to perform tasks.
• Workspace may vary from open to confined.
• May require travel to various facilities within and beyond county perimeter; may require use of personal vehicle.

Benefits:

About Health First:

At Health First, diversity and inclusion are essential for our continued growth and evolution. Working together, we strive to build and nurture a culture that recognizes, encourages, and respects the diverse voices of our associates. We know through experience that different ideas, perspectives, and backgrounds create a stronger and more collaborative work environment that delivers better results. As an organization, it fuels our innovation and connects us closer to our associates, customers, and the communities we serve.