Case Management Associate- Full Time, Days, 8 AM - 4 PM, Inpatient Care Management, Atlantic Health

Description
Responsible for assisting with the continuum of care: performing tasks identified by the case management team for discharge planning, utilization management, and care coordination support.


Principal Accountabilities:


1. As assigned, provide support to the RN Case Managers and Social Workers in completing routine post-acute care arrangements. This includes setting up routine post-acute services according to MD orders.
2. Completes tasks related to transfer of patients to post-acute care facilities including: a. Communication with facility related to bed availability, including use of case management electronic discharge systemb. Sharing of internal referral information electronically or via faxc. Assuring transfer of documentation/medical record complete d. Arranging transportation, confirmation of arrangements, and communication with families regrading transfer arrangements e. Maintaining and managing authorizations of post-acute settings, such as skilled nursing facilities, home care agencies, infusion service, durable medical equipment services, hospice, acute rehab, and long-term acute care facilities f. Demonstrating independence and proactive initiation of duties related to transfer of patients described above
3. Assist the department in maintaining authorization or overcoming coverage denials by payers by providing medical records as demanded or required.
4. Arrange medical transportation where required, including receiving insurance or medical group authorization.
5. Prepare and fax necessary documentation/information to facilitate prior authorization
6. Follow up on the above referrals by phone to ensure receipt of referral to intended company/facility and ensure all necessary information/documentation was provided. Receive and document authorizations requested.
7. Secures requested information for the healthcare team, patient, and/or family. This could include prescription availability, insurance requirements, and community resources
8. Uses case management electronic system to support case management, utilization management and discharge planning process, as directed
9. Supports the case management staff in tasks related to care coordination, discharge planning, and/or utilization management
10. Assist with data collection
11. Keeps team members updated with progress of assigned tasks. Escalates issues to case manager, social worker or leadership staff in a timely manner.
12. Documents accurately and thoroughly all transactions during the shift, according to department policy.


Qualifications

Required:
1. High School diploma or GED equivalent
2. Minimum two years' experience with a medical group, managed care organization, utilization management, hospital admitting, or medical nursing unit

Preferred:
1. Associate degree preferred
2. Hospital and/or insurance experience preferred.