- Maintains census board with patients' plan of care, coverage status, discharge plan, and related information
- Generates, prints and distributes census reports from department computer system.
- Processes requests for clinical reviews on all patients including patients with length-of-stay of two or more days
- Sends patient clinical reviews and related documentation to managed care companies. Performs follow up on patient approval status.
- Receives approvals from managed care companies, informs stakeholders and updates records accordingly.
- Monitors discharges and intents and generates related reports, as required
- Communicates with nursing homes and homecare agencies to facilitate patient discharge planning.
- Assist clinical staff with administrative aspects of closing out cases
- Participates in healthcare team huddles and rounds, as required.
- Facilitates processing of retro clinical reviews:
- Enters required information into department computer system.
- Communicates with Medical Records to obtain required documentation.
- Reviews status of retro clinical reviews and triages each case to next appropriate facilitator (i.e Appeals RN, Physician Advisor, etc.).
- Facilitates processing of managed care denials:
- Generates, prints and distributes denial documentation.
- Enters required information into department computer system.
- Communicates denial status to appropriate Case Manager.
- Collects appeal documentation from clinical team members and distributes to appropriate managed care company Performs follow up on patient approval status
- Receives, records and maintains documentation of appeal outcomes.
- Closes out cases accordingly in department computer system
- Collaborates with internal stakeholders on related special projects, as needed.
- Performs receptionist duties including, but not limited to:
- Greets, screens and directs visitors to department.
- Schedules and arranges meetings, as requested.
- Answers telephone, directs calls, and takes and relays messages.
- Opens, logs and distributes department mail.
- Performs related duties as required.
- High School Diploma or equivalent, required. Business school graduate, preferred.
- Minimum of six (6) months related experience (case management, financial counseling, medical billing, insurance verification, and/or healthcare), required.
- Working knowledge of Microsoft applications, required.
- Knowledge of medical terminology, required.
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Case Management Asst - Staten Island, United States - Northwell Health
Description
Job Description
Performs a variety of clerical duties supporting daily Case Management activities and department clinical staff.
Job Responsibility
*ADA Essential Functions
Job Qualification
*Additional Salary Detail
The salary range and/or hourly rate listed is a good faith determination of potential base compensation that may be offered to a successful applicant for this position at the time of this job advertisement and may be modified in the future.When determining a team member's base salary and/or rate, several factors may be considered as applicable (e.g., location, specialty, service line, years of relevant experience, education, credentials, negotiated contracts, budget and internal equity).
