Care Management Associate

Care Management Support Position

This position provides support to the Care Management Team to ensure that the day to day operational functions of the department are met in a timely manner. This position includes collaboration with third party payers as well as post-acute providers. This position will also be responsible for timely and appropriate documentation within the electronic Care Management System.

Minimum Qualifications:

Education, Certification, and/or Licensure:

1. High School diploma or equivalent.

Experience: 1. Two (2) years administrative experience.

Preferred Qualifications:

Education, Certification, and/or Licensure:

1. Associates or advanced degree.

Experience: 1. Two (2) years' experience in a health care setting. 2. Hospital, home health, or payer relations experience. 3. Clerical experience in utilization management, discharge planning or case management. 4. One (1) year of ICD9/CPT Coding or Medical Terminology experience.

Core Duties and Responsibilities:

1. Greets visitors and health care personnel promptly and professionally; screens visitors and telephone calls to determine urgency of contact and to facilitate appropriate routing or referral; representing Care Management in a positive manner.

2. Effectively communicates clinical information with payer to obtain authorization for post-acute services/medications and documents interactions in patient's electronic medical record (EMR) along with timely communication with Care Management staff.

3. Participates in discharge planning activities (e.g. contact of post-acute care facilities, other community resources and transportation) as needed to ensure a timely patient discharge and appropriate linkage with post-acute providers.

4. Provides prompt feedback regarding payer determinations to Supervisor/Care Manager, enabling them to evaluate/redirect the current patient plan of care in order to streamline the delivery of service.

5. Function as placement specialist, as required, to include research for preferred providers for HHC/DME/Acute Rehab/SNF/LTACH placement.

6. Proactively communicates any change in payer information to Supervisor/Care Manager and documents changes appropriately.

7. Verify with patient financial counseling that all payment sources have been explored and updated in the patient's electronic medical record (EMR).

8. Participates in reimbursement, certification and authorization related activities (e.g. faxing or copying required information) as required.

9. Contacts and coordinates with referral agencies to arrange provision of ordered equipment and associated services when appropriate, as directed by Care Managers.

10. Collects copies and transmits pertinent clinical and patient demographic information required to complete arrangements for post-discharge care and/or placement, as directed by the Care Managers.

11. Coordinates and arranges transportation and community services, as directed by care managers.

12. Provides secretarial and clerical support, including faxing, copying charts, filing, typing and scanning.

13. Ensures payer and customer satisfaction through effective communication and positive customer service skills at all times.

14. Maintains confidentiality of communications.

15. Using independent judgment prioritizes appropriately to ensure efficient utilization of time.

16. May serve as back up to the Administrative Assistant for Care Management in their absence.

Physical Requirements:

1. Prolonged periods of standing or sitting.

Working Environment:

1. Flexible hours to include weekends and holidays. 2. May include some patient interaction.

Skills and Abilities:

1. Excellent verbal and written communication skills.

2. Ability to work collaboratively with health care professionals at all levels to achieve established goals and improve quality outcomes.

3. Basic computer knowledge and ability to operate standard office software.

Additional Job Description:

Scheduled Weekly Hours: 40

Shift: Exempt/Non-Exempt: United States of America (Non-Exempt)

Company: WMCH Weirton Medical Center

Cost Center: 403 WMCH Care Management

Address: 601 Colliers Way Weirton West Virginia

Equal Opportunity Employer

West Virginia University Health System and its subsidiaries (collectively "WVUHS") is an equal opportunity employer and complies with all applicable federal, state, and local fair employment practices laws. WVUHS strictly prohibits and does not tolerate discrimination against employees, applicants, or any other covered persons because of race, color, religion, creed, national origin or ancestry, ethnicity, sex (including gender, pregnancy, sexual orientation, and gender identity), age, physical or mental disability, citizenship, past, current, or prospective service in the uniformed services, genetic information, or any other characteristic protected under applicable federal, state, or local law. All WVUHS employees, other workers, and representatives are prohibited from engaging in unlawful discrimination. This policy applies to all terms and conditions of employment, including, but not limited to, hiring, training, promotion, discipline, compensation, benefits, and termination of employment.