Case Management Coordinator, Full Time
Cornerstone Healthcare Group
- Westminster, CA
- Permanent
- Full-time
Req ID 501165 Post Date 03/06/2024 Save JobDescriptionScionHealth is committed to a culture of service excellence as demonstrated by our employees' adherence to the service excellence principles of Pride, Teamwork, Compassion, Integrity, Respect, Fun, Professionalism, and Responsibility.As our most acute level of care, our specialty hospitals offer the same critical care patients receive in a traditional hospital or intensive care unit, but for an extended recovery period. Our clinicians play a vital role in the recovery process for chronic, critically ill and medically complex patients.Job Summary: Under the supervision of the Director of Case Management (DCM) or designee, the Case Management Coordinator completes various duties to enhance the efficiency of the Case Management Department, as well as support the daily functions of the case managers. This role assists in securing arrangements for the discharge transition and post-acute services. Works with the case management team to monitor and obtain insurance verifications and concurrent authorizations. Assist with denial prevention and management as requested, aiding with the peer-to-peer coordination, and denials/appeals tracking. This position serves as a liaison between the Case Management Department, payers, post-acute providers, and various other entities.Essential Functions:
- Provides assistance to the case management staff, including but not limited to, creating and sending referral packets, organizing admission and discharge patient records, making phone calls, obtaining signatures, or any other assistance needed determined by the DCM.
- Assists the case management team in scheduling family conferences.
- Assists the case management team by making necessary arrangement for post-discharge follow up care.
- Functions as the point of contact and liaison for the hospital Case Management Department staff regarding clinical insurance review completion and/or issues.
- Forwards the necessary patient clinical information for all admission, concurrent, and retrospective insurance reviews to payers for the completion of medical necessity reviews.
- Monitors, follow-up, documents, and tracks payer responses/requests of completed clinical reviews, including approvals, appeals, and denials, and communicates these to the appropriate personnel [hospital staff, physician, DCM, Case Manager, Clinical Denial Management, and Centralized Business Office (CBO)]
- Monitors and tracks the total hospital certified days of the patient for payers (commercial, managed care, and Medicaid) and communicates missing certifications to the DCM, Case Manager, and CBO.
- Initiates and completes insurance pre-certification for patients lacking certification. Communicates pre-authorization outcomes to appropriate personnel (hospital and CBO).
- Organizes and prepares the necessary clerical elements for the weekly Interdisciplinary Team Meeting and other Case Management meetings.
- College degree in healthcare related field a plus
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