Case Management Representative - Sugar Land, United States - Houston Methodist Sugar Land Hospital

Houston Methodist Sugar Land Hospital
Houston Methodist Sugar Land Hospital
Verified Company
Sugar Land, United States

2 weeks ago

Mark Lane

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Mark Lane

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Description

At Houston Methodist, the Case Management Representative position is responsible for providing clerical assistance and data management support to the case management and social work department to facilitate efficient utilization of resources and discharge planning including referrals management, communication and collaboration with post-acute care providers, access to agencies and other community resources and transportation.

This position may perform some secretary duties and performs a wide variety of administrative duties of a higher complexity in support of Case Management operations.

In addition, the CM Rep position performs independent actions necessary to provide competent and professional assistance to meet the needs of social workers/case managers and patients.

This position also coordinates, oversees, records, and transmits information pertinent to the resource management of patients to next level of care providers.


PEOPLE ESSENTIAL FUNCTIONS

  • Serves as a department resource for questions related to case management activities. Communicates in an active, positive, and effective manner to all interprofessional health care team members. Reports pertinent patient care and family data in a comprehensive and unbiased manner. Performs phone call and communication triage, troubleshoots and routes issues to appropriate individuals, assists in resolution of nonclinical issues as needed
  • Facilitates and arranges acquisition of postacute needs, as directed, and in collaboration with the clinical team. Follows payor/reimbursement practices and regulations that may impact the patient's plan of care
  • Provides appropriate and timely communication, update, and documentation to the referring personnel to keep them informed of the status of the request
  • Conducts self in a manner that is congruent with cultural diversity, equity, and inclusion principles. Contributes towards improvement of department scores for employee engagement, i.e., peertopeer accountability

SERVICE ESSENTIAL FUNCTIONS

  • Assists the department in distributing required notices, including the Medicare Notice of Discharge to patients, securing signatures on the form from the patient or their legal representative, and answering questions regarding the appeal process
  • Distributes the Medicare Notice of Discharges to identified patients, including capturing patient and their legal representative's signatures, answering any questions regarding the appeal process
  • Coordinates with the clinical staff to prioritize placement requests. Provides necessary documentation to facilitate postacute services
  • Assists with clerical and clinical functions for patients, physicians, and staff. Provides administrative support as needed, including scheduling followup appointments, and confirming the provision or delivery or postacute services or equipment

QUALITY/SAFETY ESSENTIAL FUNCTIONS

  • Participates in quality improvement initiatives and collects data for use in department performance improvement as directed. Maintains timelines for follow up and prioritization of department projects and tasks
  • Updates and maintains resources, information and database or directories elated to postacute providers and insurance contacts to facilitate timely communication and coordination as needed

FINANCE ESSENTIAL FUNCTIONS

  • Informs social worker/case manager of the patients' available benefits through insurance/managed care provider. Assists in providing community resources/services to uninsured patients as requested Case Management staff
  • Participates in reimbursement/certification and authorizationrelated activities as directed. Documents approvals and authorization numbers from payors. Logs communications and provides information to social workers and case managers, business office/patient access, etc. on insurance/managed care benefits
  • Supports and assists with concurrent insurance denials and appeals process, transmission of utilization reviews to insurance companies, coordination of peer discussions as directed by the clinical team. Documents authorization, approvals, and denials

GROWTH/INNOVATION ESSENTIAL FUNCTIONS

  • Maintains awareness of payor/reimbursement practices and regulations that may impact patient's plan of care and confers with care coordinators and social workers to prioritize placement requests
  • Seeks opportunities to identify selfdevelopment needs and takes appropriate action. Ensures own career discussions occur with appropriate management. Completes and updates the My Development Plan on an ongoing basis


This job description is not intended to be all-inclusive; the employee will also perform other reasonably related business/job duties as assigned.

Houston Methodist reserves the right to revise job duties and responsibilities as the need arises.


EDUCATION

  • High School diploma or equivalent education (examples include: GED, verification of homeschool equivalency, partial or full completion of postsecon
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