The Care Management Assistant provides support to the department by performing administrative and clerical functions.
This position supports discharge planning and/or utilization review by demonstrating flexibility and teamwork in managing and performing various tasks within the office; greeting visitors to the department; displaying appropriate maturity and judgment in dealing with a variety of stakeholders and situations.
This position has access to confidential patient, system and financial information.
This position makes decisions independently and/or in collaboration with others and does not perform direct patient care.
Job Duties & Responsibilities:
Assists with utilization review process including faxing and scanning clinical reviews, follow up on authorizations and denials, responding to telephonic inquiries from payer representatives regarding admission and discharge information and data entry related to progression of care delays.
Escalates payer requests for clinical information as appropriate.
Ensures all patients receive appropriate notification regarding level of care designation at time of initial hospitalization and of any subsequent changes, including issuing Important Message from Medicare (IM letters) or observation notices, in accordance with state and Federal regulations
Assists health care team with discharge coordination of post-acute services including contacting post-acute vendors for availability of goods and services, verifying service areas and faxing appropriate clinical information for post-acute referrals.
In coordination with clinical team, assists patients/families in selecting post-acute vendors in accordance with state and Federal regulations related to patient choice.
Escalate issues or concerns as appropriate
Assist department leadership with coordination and preparation of meetings, interviews, conference calls, obtaining meeting rooms - including, but not limited to Committee meetings, staff meetings, interviews, peer to peer.
Provide clerical support to department including, but not limited to, sorting/distributing mail and faxes, ordering office supplies, maintaining fax/phone list, meeting minutes, updating communication/huddle boards and department newsletter.
Participates on departmental and hospital committees, and taskforces as assigned.
Promotes effective communication between departments and entities, acting as a liaison to facilitate information sharing, collaborative problem solving and adequate provision
Assists with requests for information from denials/appeals, agency transfer summaries, community support agencies, insurance companies, insurance verifiers, etc.
Education Requirements:
High School Diploma or GED
Preferred Education-Associates degree in health related field
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