Care Management Assistant - Case Management

Summary:

This position provides technical and clerical support to the Case Managers and Social Workers for discharge arrangements, acute care placements, continued length of stay and levels of service are appropriate as provided. The Case Management Assistant provides support by timely arrangements per the established discharge plan. The assistance to Case Manager and Social Workers includes clerical duties such as faxing forms, completion and submission of clinical reviews; collaborate with the Care Management Team. The Care Management Assistant receives all payers initial queries and documents authorization and notifies CM of the same. Additionally understands denial of services process and works with team members to appeal cases and assists team to ensure that 100% of admissions are authorized within 24 hours and concurrent reviews are communicated timely.

CHRISTUS Santa Rosa Hospital - Westover Hills (CSRH-WH) is a 150-bed hospital serving the fastest growing area of San Antonio. Specialized care includes orthopedic and surgical services, ICU, women's services, a newborn nursery, comprehensive cardiovascular care from diagnostics to open heart surgery, vascular lab, sleep center, emergency services, the CHRISTUS Weight Loss Institute, wound care, rehabilitation, and more. The campus also boasts an Outpatient Imaging Center and three medical plazas, one of which houses our CHRISTUS Santa Rosa Family Medicine Residency Program and CHRISTUS Santa Rosa Family Health Center.

Responsibilities:

• Prepares daily census for each Case Manager/Social Worker.
• Discharge Arrangement: In collaboration with Social Services proactively makes arrangements to meet facilities Discharge Time.
• Prints the following reports on a daily basis for the Case Managers and Social Workers:
• CM Daily Census
• CM Discharge Report
• CM Daily Census with Prior Visit
• Provides the assistance with discharge arrangements early in the patient's admission.
• Facilitates and assist with discharge arrangements.
• Communicates and documents completion of discharge task for Case Manager or Social Worker.
• Follow up phone calls (ie CPS, APS) to identify referral identification.
• Research different pharmaceutical companies to assist with medication purchase.
• Research Medicare Part D program of patients.
• Assist with obtaining Medicaid transportation and meal tickets.
• Obtain Durable Medical Equipment and Home Health services.
• Provide support to Social worker on complex patients/families.
• Collaborates with team members by sharing relevant and accurate information, date and reports as evidenced by:
• Identifies appropriate team members with whom to share information
• Identifies information pertinent to patient treatment plan
• Summarizes the discussion and follows through
• Problem resolution
• Develop memorandums or letters to multiple entities.
• Utilizes knowledge and expertise to ensure that initial and continued stay clinical reviews are communicated timely to respective payers. (E)
• Take initiative to provide pre-admission authorization review to respective payers. (E)
• Assist case managers with documentation of Levels of Service based on MS DRG and accepted LOS BENCHMARK (E)
• Provides information to Case Managers timely every morning, noon and mid afternoon regarding inpatient concurrent review (E)
• Takes initiative to obtain clinical form Utilization Review (UR) notes for requested and supplies information to payer. Retrospective review (M)
• Enters data or collaborates with Case Managers for IS/SI - monitors daily UR notes for needed documentation. (E)
• Obtains and enters documentation of required pre-admission approvals/authorizations. (E)
• Takes initiative to collect all data to appeal a denial. Implements appeal process, completes investigations, utilize denial worksheet. (E)
• Print reports to be faxed to third party payers.
• Identify patients that need to be fax to appropriate destination and review confirmation sheet.
• Responsible for the following duties on a daily basis
• Process interim billing as request by PFS
• Maintains Resource Book
• Updates P&P Manual for their location
• Assist Case Managers with facsimiles to multiple entities, minimal contact with outside entities, and upon approval of patient to contact Case Manager for further instructions.
• Runs Milliman Care Guidelines for Case Managers daily.
• Document in the notes section ABS that review was faxed.
• Guest Relations/Communications; Demonstrates positive role modeling of customer relations (customer include patient, physicians, other health care team members, and payers, etc.) Use AIDET and KWKT appropriately.
• Change Management: Acts as a catalyst for change in the organization; responds to change with flexibility and adaptability to overcome organizational resistance and inertia; demonstrates the ability to focus and energize associates to work together for change; gains maximum support from others for new initiatives.
• Shaping the Organization: Devises systems and processes which improve the overall functioning of the organization; ensures that the organization's systems, processes and people are integrated to achieve the mission in the most efficient and effective manner.
• Managing Process: Translates strategies into action steps; clearly assigns responsibility for decisions and tasks; sets clear objectives; monitors progress and achieves results.
• Achieving Results: Demonstrates the confidence, drive and ability to face and overcome challenges and obstacles to achieve organizational goals.
• Enhancing Clinical Outcomes: Works to improve the healthcare process in general and devises and implements strategies specifically directed at improving clinical outcomes.
• Cultural specific implications: Appropriately adapts assigned assessment, treatment and/or service methods to accommodate the unique physical, psychological, cultural and other needs of each member served.
• Perform other duties as assigned. (M).

Requirements:

Education

• High school diploma or equivalent is required.
• Medical Office Secretary/Medical Assistant (MOS/MA) accreditation (optional).
• Excellent verbal and written communication skills
• Word processing skills/Computer skills
• Attention to detail and accuracy
• Ability to prioritize and manage multiple projects simultaneously Follows through each aspects of work assignments to successful completion

Experience

• Requires one to two years of clerical experience, customer services, communication skills, computer skills, and communication skills to be the liaison between CSR and other facilities.
• Experience in working in hospital environment and worked directly with patients/customers.
• Medical terminology preferred.
• Prefer bilingual
• If LVN/LPN licensed, must have a minimum of two years of clinical experience.
• Utilization management experience preferred. (optional)
• Medical terminology required. Significant applicable education and/or training may be considered.

Licenses, Registrations, or Certifications

• MOS/MA accreditation or current LVN/LPN licensure (optional)

Work Type:

Full Time

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