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Case Management Associate Req #: 30126184 Category: Admin Support/Clerical Facility: Beaumont Hospital FH Department: Care Management Schedule: Part time Shift: Days Job Details:Position Title: Case Management AssociateGeneral Summary: Under general supervision, this position is responsible for providing direct case management support services to include but not limited to concurrent and retrospective telephonic/fax clinical review to external managed care review entities to obtain authorization of patient's hospitalization and continuing care services. Verifies patient's insurance plan status and coverage of benefits for supplies, durable medical equipment, home health care services and extended care facilities. Coordinates and transmits notification, order and/or delivery of equipment/supplies with patient referrals, and/or family/significant other, Case Manager and community entity.Reviews and screens using pre-established objective criteria, each patient's medical record in accordance with hospital, department, and managed care policies and procedures, in an effort to maximize patient care while utilizing hospital resources in a cost-effective manner. Promotes maximum hospital reimbursement by the use of various systems to code and categorize patient information for reimbursement purposes, maintain patient medical and treatment histories, perform coordination of pre-determined programs, clinical appeal processes, concurrent coding and application of the utilization management systemEssential Duties:Performs all activities related to the concurrent and retrospective external managed care review authorization.Abstracts and documents clinical review from the medical record and completes the external managed care telephonic/review process. Enters data into appropriate information system.Communicates all denials and status appeals to appropriate management and appropriate internal and department external staff.Coordinates external managed care review entity appeal of denial, tracks, records and reports status of appeal to appropriate staff.Performs all activities related to the concurrent and retrospective coordination of continuing care review.Reviews, identifies and verifies insurance and benefit coverage for continuing care services, durable medical equipment, home health services and extended care facility. Electronically documents status in to appropriate information system and provides notice to Case Managers within 4 hours.Coordinates notification of continuing care patient transfer or requests for extended care facility beds to appropriate agency. Electronically documents status into appropriate information system.Gathers information and prepares a variety of statistical reports, summaries or drafts for review by management.Performs concurrent coding.Reviews, screens, certifies and records information regarding necessity of patient admissions, short stay/observations, and necessity of continued stays.Communicates and follows up with physician advisors, attending physicians, house staff, case managers, social workers, nursing and ancillary departments regarding medical necessity and appropriateness of admissions, short stay/observations, continued stays and timeliness of treatment, service and dischargeProvides concurrent education regarding SI/IS criteria and managed care regulations to attending physicians, house staff and other hospital personnel on an on-going basis. Performs staff in-service education and audits quality of coding processes.Standard Qualifications:bull;Requires minimum of an Associate Degree in Health Information Systems with postsecondary certificate in an Accredited Health Record Technician (AHRT) or Registered Medical Records and Health Information Technician (RHIT) program from an accre
