Case Management Tech

Covenant HealthCare

US:MI:SAGINAW

DAY SHIFT

FULL TIME BENEFITED

Summary:

Demonstrates excellent customer service performance in that his/her attitude and actions are at all times consistent with the standards contained in the Vision, Mission and Values of Covenant HealthCare and the commitment to Extraordinary Care for Every Generation. The Case Management Technician (CMT) position will serve to support the Clinical Resource Management Department in providing support for the discharge planning and utilization review processes.

In the discharge planning process, the CMT will attend morning huddles on each assigned unit, communicate with and coordinate post discharge services as directed by the RN and Social Work Case Managers. In the utilization review process, the CMT will work in collaboration with the Utilization RN and serve as the primary intake for all payor requests for clinical review for certification of hospital services including admissions, continued stay days, surgeries, and post discharge provider certification. The CMT will facilitate delivery of the clinical information as requested, track payor disposition and communicate all payor determinations to the Care Management Hospital Care Coordinators. Additionally, the CMT will perform general administrative duties as required.

Responsibilities:

Works collaboratively with the RN/SW Case Managers using a "customer service" framework to facilitate timely discharges and support a smooth transition to the next level of care for Covenant Health patients, to function in a Liaison role for Home Health, Hospice, SNF, LTCH discharges, including DME medical equipment.

Coordinates the communication and referrals to post discharge providers including home health, home and inpatient hospice, Long Term Acute Care facilities, Skilled Nursing facilities, Assisted Living Facilities, transportation and any other type of post discharge provider of services as requested by the RN/SW Case Manager.

Serves as a contact/liaison for external providers regarding post discharge referrals, as directed

Gathers all pertinent information required by provider type and sends to providers as requested by the RN/SW Case Managers using the electronic medical record program and directed.

Follows the organization's Patient's Rights of Choice and Release of Information policies and procedures and identified communication system (fax, email, US mail, etc.) to electronically send the pertinent information for each referral type, as directed

Conducts follow-up phone calls with providers, as needed, to confirm referral receipt and obtain disposition (approval or rejection)

Updates RN/SW Case Managers to advised of status and outcomes timely and expeditiously

Coordinates the discharge date and time with the CH team members and post discharge providers

Conducts research to identify providers for specific services as needed by the RN/SW Case Managers. Schedules follow-up appointments, as requested, to support post discharge follow-up care including, but not limited to, physician office visits, wound care clinic visits, infusion center serviced, etc. as time allows

Delivers the Medicare Important Message from Medicare Notice #2 as requested by the RN/SW Case Managers.

Serves as the primary contact/intake for all internal and external requests for clinical information and initiates the payor certification process

Serves as the primary communicator to the patient-assigned CC within 30 minutes from request receipt when initial clinical information is required by a payor and/or when a continued stay review is needed for certification

Effectively uses the CH communication system (phone, pager, text, fax, email, etc) system to communicate requests for clinical information

Documents all payor certification activities on the Clinical Management departmental tracking system and in the CH business office systems to ensure adequate communication of all payor certification activity including, date clinical information submitted, authorization number, days certified, denied or level of care reduction, concurrent appeals, etc.

Tracks the certification process activity on the established tracking system to ensure timely clinical information is received and communicated to the Payor. Also tracks to ensure authorization is received from the payor within 24 hrs or 1 workday from request.

Supports the payor certification process by forwarding clinical information to the payor as requested by the payor

Follows-up to ensure that all certifications determinations are received within 1 working day from submitting the clinical information.

Communicates to CRM leadership when a case has been referred to the payor's Medical Director, a reduced level of care or denial determination has been received or if 2 calls have been placed to the payor for payor disposition without response.

Utilizes the chain of command to resolve conflicts and problems.

Ensures compliance with all state, federal and third party payor rules, regulations and requirements

Performs general administrative duties to support departmental operations as needed

Other information:

EDUCATION/EXPERIENCE REQUIREMENTS

High School graduate or equivalent

Medical Terminology, or willingness to complete within six (6) months of hire

Preferred:

Graduate of two-year degree program or 2 years work experience in a medical environment.

KNOWLEDGE/SKILLS/ABILITIES

Knowledge and expertise in developing and using data management tools such as Excel, Access, etc. Experience with office machines (i.e. copier, fax, telephone), computer terminal/personal computer, software (i.e. word processing, project management, spreadsheets, etc.)

Expertise and knowledge of third party payor requirements and regulations including Medicare/Medicaid, managed care payors, commercial insurance companies, worker's comp, etc.

Ability to work within strict time frames when responding to verbal and written requests for review.

Must be flexible and well organized and able to prioritize.

Sound knowledge of medical terminology

Skill in establishing and maintaining cooperative and "team" oriented working relationships with others.

Highly effective communication skills, both verbal and written

Strong organization, time management and follow-through skills

Solid problem solving and decision-making skills

Demonstrates flexibility and assertiveness

WORKING CONDITIONS/PHYSICAL DEMANDS

Ability to maintain regular, punctual attendance consistent with the ADA, FMLA and other federal, state and local standards

Frequently Standing, Walking, Sitting, Using hands to finger, handle, feel, talking, hearing, near vision, far vision, depth perception, visual accomodation, color vision, field of vision

Occasioanly lifting, carrying, pushing, pulling, climbing, balancing, stooping, kneeling, crouching, squating, crawling, twisting, reaching, lifting up to 10 lbs.

NOTICE REGARDING LATEX SENSITIVITY IN APPLICANTS FOR EMPLOYMENT.

It has been determined that Covenant HealthCare cannot provide a latex safe or latex free work environment at any of its facilities. Unfortunately, that means that any individual, including an applicant or an employee, is likely to be exposed to latex while on Covenant's premises. Therefore, latex tolerance is considered to be an essential function for any position with Covenant.