Case Management Technician

Job Requirements Job Summary The Case Management Technician is responsible for supporting the core functions of discharge planning and utilization management, carrying out associated routine tasks. These include assisting with arrangement of post discharge resources such as returns to nursing home, home care, DME, and transportation services, and supporting communication between the hospital, customers and payors through phone, fax, notifications and data entry. Works under the under the direction of a licensed RN Care Manager or Social Worker.

DISCHARGE PLANNING

Arranges for transportation at discharge for patients requiring post acute transfers via ambulance and wheelchair vans. Under the direction of a licensed professional, and with consideration of the patient's insurance coverage, will make appropriate referrals to home care agencies via E-discharge. Works effectively with external providers through good communication, complete documentation and follow-through to ensure efficient and smooth transition for the patient. Effectively communicates with the healthcare team regarding discharge planning activities and status. Responsible for the distribution of the Important Message from Medicare second notice per hospital policy.

UTILIZATION REVIEW

Monitors commercial reviews through daily census reports, and payor logs to avoid denial of payment to the hospital. Prints reviews and sends reviews through fax to payors within allotted timelines. Answers calls and retrieves faxes from payors to determine certifications and denials of days for reimbursement. Enters certified and avoidable (denied)days in MIDAS. Creates logs of daily communication with payors. Follows up on and completes all pending Certifications. Ensures Payor satisfaction through positive and effective communication.

COMPLIANCE

Coordinates with Case Management staff to anticipate discharges and delivers and reviews the Important Message for Medicare to Medicare recipients within 48 hours of discharge. Work Experience Education High School Diploma or GED (Required) Combination of relevant education and experience may be considered in lieu of degree.

Vocational / Technical

Degree (Preferred) Certification / Licensure / Registration CNA (Preferred) Experience and Skills 0

• 1 year related Technician experience (Required) 0
• 1 year experience in hospital/health care setting (Required) 0
• 1 year Experience with medical terminology.

(Preferred)

Required Skills:

Strong Verbal Communications Skills, Strong Written Communications Skills, Excellent Interpersonal Skills, General Clerical Skills, Basic Computer Skills, Excellent Organizational Skills, Strong Customer Services Skills