Integrated Case Management Specialist

Integrated Case Management Specialist

Our team members are the heart of what makes us better.

At Hackensack Meridian Health we help our patients live better, healthier lives and we help one another to succeed. With a culture rooted in connection and collaboration, our employees are team members. Here, competitive benefits are just the beginning. It's also about how we support one another and how we show up for our community.

Together, we keep getting better - advancing our mission to transform healthcare and serve as a leader of positive change.

The Integrated Case Management Specialist performs selected services and functions related to insurance management with various payors, ortho calls, payer communications and support of the Care Coordinators. Prepares required Appeals and Denial information for processing and follows up on receipt of communication including Livanta appeal management process. Oversees the sorting and distribution of mail in the department. Answers case management and social work phones. Medicaid appointment, all discharge functions for the Care Coordinators, including seventy hour discharge report and providing patients with the IM Letter from Medicare prior to discharge.

Responsibilities

A day in the life of a Integrated Case Management Specialist at Hackensack Meridian Health includes:

• In collaboration with the Care Coordinator, reviews daily admission data to verify inpatient insurance coverage, pre-certs, authorized days, and reviews needed. Alerts the CC to potential problems with any of the above.
• If the authorization/precert information is missing or incorrect, the Case Management Specialist will contact admitting to obtain the necessary and accurate information.
• Daily log reconciliation.
• Utilizes EPIC computer software to retrieve necessary information, inclusive of free text fields, to support the case management, utilization review process.
• Retrieves information for the Physician Advisors as needed.
• Works the DNFB report to determine outlier days, approved days, etc., and releases accounts as appropriate.
• Checks admission and discharge dates.
• Enters LAD into EPIC.
• Keeps Utilization Review RN current on updates needed for payors.
• Enters all documentation into EPIC systems for denials/ lower level of cares.
• Contacts insurance company for benefit coverage and obtains authorizations when needed.
• Answers all phones, including social work and case management office lines.
• Performs office support services to facilitate efficient running of the department, i.e., phone call management, messages, mail/correspondence, ordering supplies and assisting the screeners from other facilities, 72 hour discharge report, weekend discharge report.
• Assists CC through telephone, personal or written communications. Also serves as an interpreter for the department if certified by HUMC. Participates in quality improvement efforts for the department to assist in improving work efficiency, and to help meet the goals of the department, files the required documents.
• Performs other clerical support duties as delegated by the Administrator, Manager(s), CC
• As requested by CC schedules transport from HUMC to discharge destination, depending upon insurance.
• As requested by CC will locate beds for discharge to a facility and fax referral.
• As requested will order DME for patients.
• As requested will refer to community Resources.
• As requested will provide patient/ family with IM from Medicare Letter.
• As requested will arrange Medicaid appointments.
• As requested will arrange follow up appointments at MD`s office and/ or clinics.
• As requested faxes medications, once received from CC to a particular pharmacy.
• As requested participates in hospital to hospital transfers, and/or transfers back to facilities.
• As requested faxes referrals to home care, dialysis subacute rehab, acute rehab, or other facilities.
• As requested faxes applications for Medication assistance.
• Performs initial and psycho/social assessments as needed.
• All other duties as assigned.

Qualifications

Education, Knowledge, Skills and Abilities Required:

• High School diploma, general equivalency diploma (GED), and/or GED equivalent programs.
• Experience in the healthcare industry.
• Effective written, oral, and interpersonal communications skills.
• Proficient computer, word-processing and Excel spreadsheet skills.
• Ability to learn new computer systems, i.e.: EPIC, INDICIA.
• Educated in the unique clinical and discharge needs of the patients.
• Strong time management and priority-setting skills.
• Ability to work independently and as a team member.
• Self-directed with the ability to take the initiative to solve problems.

Education, Knowledge, Skills and Abilities Preferred:

• 1 year recent experience in a hospital or medical setting preferred.
• BSW/CSW preferred.