This position provides technical support to Case Managers and Social Workers to ensure acute care placements, continued length of stay and levels of service are appropriate as provided. Additionally understands denial of services process and works with team members to appeal cases. Assist the care management team to ensure that 100% of admissions are authorized within 24 hours and concurrent reviews are communicated timely.
Assist Case Managers with facsimiles to multiple entities, minimal contact with outside entities, and upon approval of patient to contact Case Manager for further instructions Develop memorandums or letters to multiple entities Utilizes knowledge and expertise to ensure that initial and continued stay clinical reviews are communicated timely to respective payers Take initiative to provide pre-admission authorization review to respective payers Assist case managers with documentation of Levels of Service based on MS DRG and accepted LOS BENCHMARK Provides information to Case Managers timely every morning, noon and mid afternoon regarding inpatient concurrent review Takes initiative to obtain clinical form Utilization Review (UR) notes for requested and supplies information to payer Retrospective review Enters data or collaborates with Case Managers for IS/SI - monitors daily UR notes for needed documentation Obtains and enters documentation of required pre-admission approvals/authorizations Takes initiative to collect all data to appeal a denial Implements appeal process, completes investigations, utilize denial worksheet Perform other duties as assigned Print reports to be faxed to third party payers Runs Milliman Care Guidelines for Case Managers daily Identify patients that need to be fax to appropriate destination and review confirmation sheet Document in the notes section ABS that review was faxed Guest Relations/Communications; Demonstrates positive role modeling of customer relations (customer include patient, physicians, other health care team members, and payers, etc Use AIDET and KWKT appropriately Responsible for the following duties on a daily basis: Process interim billing as request by PFS, Maintains Resource Book, and Updates P&P Manual Change Management: Acts as a catalyst for change in the organization; responds to change with flexibility and adaptability to overcome organizational resistance and inertia; demonstrates the ability to focus and energize associates to work together for change; gains maximum support from others for new initiatives Shaping the Organization: Devises systems and processes which improve the overall functioning of the organization; ensures that the organization's systems, processes and people are integrated to achieve the mission in the most efficient and effective manner Managing Process: Translates strategies into action steps; clearly assigns responsibility for decisions and tasks; sets clear objectives; monitors progress and achieves results Achieving Results: Demonstrates the confidence, drive and ability to face and overcome challenges and obstacles to achieve organizational goals Enhancing Clinical Outcomes: Works to improve the healthcare process in general and devises and implements strategies specifically directed at improving clinical outcomes Cultural specific implications: Appropriately adapts assigned assessment, treatment and/or service methods to accommodate the unique physical, psychological, cultural and other needs of each member served Utilizes evidences-based tools to analyze and identify trends/patterns of performance through variance reporting to improve quality, satisfaction, and decrease cost variation Notifying Case Managers when information is requested from THN on the spreadsheet Review and documents cancelled admissions Demonstrates competence to perform assigned patient care responsibilities in a manner that meets the population-specific and developmental needs of patients served by the department Appropriately adapts assigned assessment, treatment, and/or service methods to accommodate the unique physical, psychosocial, cultural, age-specific and other developmental needs of each member served
High School Diploma Work
8AM - 5PM Monday-Friday Work Type: Full Time