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Care Management Specialist - Portsmouth, United States - Bon Secours Mercy Health
Description
At Bon Secours Mercy Health, we are dedicated to continually improving health care quality, safety and cost effectiveness. Our hospitals, care sites and clinicians are recognized for clinical and operational excellence.PRIMARY FUNCTION/GENERAL PURPOSE OF POSITION:
The Care Management Specialist serves as a support and a partner with the Care Managers on patient care areas by improving the efficiency of the entire Care Management Team
EMPLOYMENT QUALIFICATIONS:
High School Graduate. Prefer some college/business school. Three years of experience in a medical office, hospital department setting or health insurance company preferred. Ability to communicate pertinent medical information. Knowledge of medical terminology preferred. Knowledge of various software applications, i.e., Microsoft Office, including Excel and PowerPoint preferred. Excellent communication, customer service, interpersonal and organizational skills. Must be able to work under considerable stress, using tact and diplomacy. Must demonstrate an ability to work independently, problem solve, and be able to resolve conflict in an assertive manner.
ESSENTIAL JOB FUNCTIONS:
Patient Placement SupportEnsure that timely referrals are made to post discharge facilities and services to enhance the continuum of care for the patient, avoid discharge delays and ensure appropriate length of stay for patient. Pro-actively coordinate with LTAC, Sub-acute, SNF/ICF, Assisted Living and Group Home placement by calling facilities directly to expedite the transfer. Also coordinate with Home Health agencies and DME companies as needed. Utilizing CarePort, provide clinical and demographic information to designated facilities observing all the guidelines associated with HIPAA requirements. Effectively documents progress in required systems to include final facility disposition with level of care.
Other ResponsibilitiesMeet with patients who do not have a Primary Care Physician (PCP) to present and discuss Bon Secours PCP options for the patient.
Deliver and explain compliance forms including the IMM, Observation notices, Code 44 letters, and IMT. Assist the care manager with discharge appeals.Maintain updated contact lists in electronic database including, but not limited to Freedom of Choice listsAuthorization ResponsibilitiesSubmit prior authorization requests to commercial insurance companies for post-acute services, including skilled nursing facilities, inpatient rehab facilities and long-term acute care facilities.
Coordinate appeals process for denied requests.Technical SkillsDocument work with patients through appropriate record keeping that follows policies and procedures. Utilize all software and other computerized applications effectively. Use of EPIC, Lyft portal, and other software systems. Follow infection control guidelines.
Many of our opportunities reward* your hard work with:
Comprehensive, affordable medical, dental and vision plansPrescription drug coverageFlexible spending accountsLife insurance w/AD&DEmployer contributions to retirement savings plan when eligiblePaid time offEducational AssistanceAnd much more*Benefits offerings vary according to employment statusAll applicants will receive consideration for employment without regard to race, color, national origin, religion, sex, sexual orientation, gender identity, age, genetic information, or protected veteran status, and will not be discriminated against on the basis of disability.
If you'd like to view a copy of the affirmative action plan or policy statement for Mercy Health – Youngstown, Ohio or Bon Secours – Franklin, Virginia; Petersburg, Virginia; and Emporia, Virginia, which are Affirmative Action and Equal Opportunity Employers, please email .
If you are an individual with a disability and would like to request a reasonable accommodation as part of the employment selection process, please contact The Talent Acquisition Team at
