City/State:

Nyack, New York Department:

Care Management Work Shift:

Day Work Days:

MON-FRI Scheduled Hours:

8 AM-4:30

PM Scheduled Daily Hours:

8

HOURS Scheduled Weekly Hours:

40

Hourly Rate/Range:

27.00 For positions that have only a rate listed, the displayed rate is the hiring rate but could be subject to change based on shift differential, experience, education or other relevant factors. Essential Job Qualifications 1.

Education:

Associate degree, Bachelors preferred 2.

Experience:

Extensive knowledge of prior authorizations, benefits, insurance coverage Knowledge of medical terminology and post-acute levels of care. Working knowledge of Medicare, Medicaid, commercial insurance, managed care authorization processes, and payer portals. Experience using Epic, CarePort, insurance portals, and electronic medical record systems preferred 3.

Training/Certification:

N/A 4.

Licensure:

N/A 5.

Other:

Strong organizational and time management skills with the ability to prioritize multiple urgent tasks. Strong critical thinking and problem-solving skills

JOB SPECIFIC COMPETENCIES

•Demonstrates the required job specific technical professional knowledge, skills and abilities. Care Coordination Support Supports RN Case Managers and Social Work Case Managers in coordinating patient transitions across the continuum of care. Assists in facilitating timely discharges by coordinating administrative aspects of discharge planning. Communicates effectively with interdisciplinary team members regarding discharge status, authorization updates, and barriers to discharge. Escalates unresolved issues or delays to the RN CM or SW CM. Insurance Authorization and Benefit Coordination Initiates and coordinates insurance pre-authorizations for Skilled Nursing Facility (SNF) admissions as directed by the RN CM or SW CM. Communicates with commercial insurance companies, Medicare Advantage plans, Medicaid Managed Care organizations, and other payers via telephone and payer portals to obtain authorization decisions. Tracks authorization status and communicates approvals, denials, or requests for additional clinical information to the RN CM or SW CM. Researches patient eligibility, benefits, coverage limitations, and payer requirements. Identifies participating in-network Skilled Nursing Facilities, Home Health agencies, Durable Medical Equipment providers, and other post-acute services based on the patient's insurance coverage. Responds to inquiries from RN CM and SW CM regarding insurance eligibility, covered benefits, network participation, and authorization requirements. undefined Post-Acute Provider Coordination Researches Medicare-certified Skilled Nursing Facilities and Home Health agencies that serve the patient's geographic area and participate with the patient's insurance plan. Assists with referral coordination through CarePort, Epic, or other designated referral platforms after patient/provider selection has been documented by the RN CM or SW CM. Maintains communication with post-acute providers regarding authorization status and approval. undefined Discharge Transportation Coordination Coordinates discharge transportation including ambulance, wheelchair van (ambulette), taxi, rideshare, and other approved transportation services. Schedules transportation through approved vendors and electronic scheduling platforms. Obtains insurance authorization for medically necessary transportation services when required. Confirms transportation arrangements with vendors, nursing staff, patients, families, and receiving facilities. Troubleshoots transportation delays or service issues to minimize discharge delays. undefined Regulatory Compliance Support Assists in identifying Medicare-certified providers available within the patient's geographic service area and insurance network. Supports documentation processes in Epic, CarePort, and other electronic systems to facilitate regulatory compliance and survey readiness. Documentation Documents authorization requests, payer communications, transportation arrangements, referral activity, and coordination efforts in designated electronic systems. Maintains complete and accurate records supporting discharge planning activities. Ensures documentation is timely, accurate, and consistent with departmental policies and procedures. Customer Service Provides courteous, professional communication with patients, families, insurance representatives, transportation vendors, physicians, and post-acute providers. Serves as a resource to the care management team regarding insurance participation, provider availability, and authorization status. Performs other duties as related and required by the department. Montefiore Nyack Hospital is an equal employment opportunity employer. Montefiore Nyack Hospital will recruit, hire, train, transfer, promote, layoff and discharge associates in all job classifications without regard to their race, color, religion, creed, national origin, alienage or citizenship status, age, gender, actual or presumed disability, history of disability, sexual orientation, gender identity, gender expression, genetic predisposition or carrier status, pregnancy, military status, marital status, or partnership status, or any other characteristic protected by law.