The Supervisor of Intake Case Management Services functions as an integral member of a multidisciplinary clinical team which manages the care of ambulatory infusion patients. They are responsible for qualifying each new patient prior to service. They supervise Intake Insurance Case Managers as assigned and serve as their primary resource while verifying patient's health benefits and coverage for infusion services. The Supervisor of Intake Case Management Services works closely with the Intake Coordinator and the referring office staff to process new referrals timely and ensure complete and accurate verification of insurance benefits. The position communicates insurance benefit information to the Patient Account Representative and other appropriate staff. They work closely with the Clinical Nurse Manager, Case Management/PAR team and the Reimbursement department in providing and promoting customer service, process flow, operational integrity, quality care and process improvement along with high service standards.
Minimum of two (2) years medical insurance case management experience required.
Previous supervisory experience required.
Associate degree or higher. Graduated from an accredited school of nursing with RN or LPN degree.
Medical terminology and coding experience required.
A record of satisfactory performance in all prior and current employment as evidenced by positive employment references from previous and current employers.
Must have the ability to manage individuals with different levels of education and experience.
Must be able to motivate staff to participate in Management and or Company goals through daily exemplary behavior combined with positive verbal reinforcement.
Must be able to assume a flexible work schedule.
Strong organizational, communication and problem solving skills.
Excellent internal and external customer service.
Competent in use of company email as means of communication, accessing the company website to view company policies and electronic medical records.
Competent in the use of company self-service payroll software (time and attendance, benefits, pay statements).
Competent in the use of Microsoft Office products and the ability to navigate Internet Explorer. Proficient in typing, word processing (Microsoft Outlook/Express, Word, Excel), and familiar with office equipment.
Proficient in the operation of CPR+.
ESSENTIAL DUTIES, FUNCTIONS & RESPONSIBILITIES
Operations and Administration:
Performs insurance verification for ambulatory infusion patients.
Obtains patient data from referring physician office for support of medical necessity; ensures data integrity.
Evaluates clinical appropriateness of referrals.
Explores all treatment scenarios to ensure best possible option for patient and company.
Provides timely acceptance and completion of new referrals.
Obtains authorization as applicable
Completes the Insurance Verification
Contacts case management, third party administrator and payor representative.
Maintains knowledge of reimbursement principles and pricing parameters.
Understands Medicare coverage principles and requirements for denial letters.
Identifies, coordinates and sends materials to payor source.
Manages specific criteria for designated payors (for example, Maximum Allowable Units).
Participates in the orientation of Intake Insurance Case Managers assigned.
Provides contemporaneous documentation related to personnel and HR matters involving direct reports.
Supervises and serves as primary resource for Intake Insurance Case Managers as assigned.
Provides on-going, clear, measurable performance expectations and feedback for staff. Guides and counsels staff consistently.
Holds staff managed accountable for responsibility inherent in their position.
Serves in a staff development/mentor role to the AIC Insurance Case Managers as assigned.
Completes performance appraisals of all staff managed according to policy.
Identifies employee strengths, developmental needs, skills, interests, and values to relate to organization needs.
Reviews and helps disseminate medical policy for various payors and therapies.
Communication and Customer Service:
Provides and documents on-going communication with payor case managers for updates, changes and authorizations.
Represents self in a professional and ethical manner and maintains courteous demeanor at all times.
Communicates with peers, supervisors and other employees in a non-threatening manner.
Takes initiative to present ideas and suggestions to leadership.
Demonstrates ability to maintain calm under pressure and cope with changing environment.
Improving Organizational Performance:
Maintains knowledge and proficiency in medical practices through continuing education, staff meetings, and workshops, and home study.
Supports the marketing efforts of Palmetto Infusion by assisting the sales team and providing educational programs to referral sources as requested.
Participates in Performance Improvement processes.
Performs other duties and projects as assigned.
Complies with all federal, state, county, and municipal laws, rules, ordinances and regulations applicable to the nurse practice act in the performance of obligations herein, as well as with applicable PI policies and personnel qualifications.
In performance of their respective tasks and duties all employees and contract employees of Palmetto Infusion are expected to conform to the following:
Adhere to all professional and ethical behavior standards of the healthcare industry.
Display a neat, clean and professional appearance at all times.
Interact in an honest, trustworthy and dependable manner with patients, employees and vendors.
Possess cultural awareness and sensitivity.
Maintain a current insurable driver's license.
Maintain professional licensure, certification and health requirements as required for this position.
The work environment characteristics described here are representative of those an employee encounters while performing the primary functions of this job. Normal office conditions exist, and the noise level in the work environment can vary from low to moderate. Limited overnight travel may be required from time to time.
All employees must uphold all principles of confidentiality and patient care to the fullest extent. This position has access to sensitive information and a breach of these principles will be grounds for immediate termination.
Disclaimer: The information on this position description has been designed to indicate the general nature and level of work performance by employees in this position. It is not designed to contain, or be interpreted as, a comprehensive inventory of all duties, responsibilities and qualifications required of employees assigned to this position. Employees will be asked to perform other duties as needed.