Case Management Representative
Case Management Representative
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Salary Not Disclosed
1 Vacancy
Job Description
At Houston Methodist the Case Management Representative position is responsible for providing clerical assistance and data management support to the case management and social work department to facilitate efficient utilization of resources and discharge planning including referrals management communication and collaboration with postacute care providers access to agencies and other community resources and transportation. This position may perform some secretary duties and performs a wide variety of administrative duties of a higher complexity in support of Case Management operations. In addition the CM Rep position performs independent actions necessary to provide competent and professional assistance to meet the needs of social workers/case managers and patients. This position also coordinates oversees records and transmits information pertinent to the resource management of patients to next level of care providers.
- Serves as a department resource for questions related to case management activities. Communicates in an active positive and effective manner to all interprofessional health care team members. Reports pertinent patient care and family data in a comprehensive and unbiased manner. Performs phone call and communication triage troubleshoots and routes issues to appropriate individuals assists in resolution of nonclinical issues as needed
- Facilitates and arranges acquisition of postacute needs as directed and in collaboration with the clinical team. Follows payor/reimbursement practices and regulations that may impact the patients plan of care
- Provides appropriate and timely communication update and documentation to the referring personnel to keep them informed of the status of the request
- Conducts self in a manner that is congruent with cultural diversity equity and inclusion principles. Contributes towards improvement of department scores for employee engagement i.e. peertopeer accountability
SERVICE ESSENTIAL FUNCTIONS
- Assists the department in distributing required notices including the Medicare Notice of Discharge to patients securing signatures on the form from the patient or their legal representative and answering questions regarding the appeal process
- Distributes the Medicare Notice of Discharges to identified patients including capturing patient and their legal representatives signatures answering any questions regarding the appeal process
- Coordinates with the clinical staff to prioritize placement requests. Provides necessary documentation to facilitate postacute services
- Assists with clerical and clinical functions for patients physicians and staff. Provides administrative support as needed including scheduling followup appointments and confirming the provision or delivery or postacute services or equipment
QUALITY/SAFETY ESSENTIAL FUNCTIONS
- Participates in quality improvement initiatives and collects data for use in department performance improvement as directed. Maintains timelines for follow up and prioritization of department projects and tasks
- Updates and maintains resources information and database or directories elated to postacute providers and insurance contacts to facilitate timely communication and coordination as needed
FINANCE ESSENTIAL FUNCTIONS
- Informs social worker/case manager of the patients available benefits through insurance/managed care provider. Assists in providing community resources/services to uninsured patients as requested Case Management staff
- Participates in reimbursement/certification and authorizationrelated activities as directed. Documents approvals and authorization numbers from payors. Logs communications and provides information to social workers and case managers business office/patient access etc. on insurance/managed care benefits
- Supports and assists with concurrent insurance denials and appeals process transmission of utilization reviews to insurance companies coordination of peer discussions as directed by the clinical team. Documents authorization approvals and denials
GROWTH/INNOVATION ESSENTIAL FUNCTIONS
- Maintains awareness of payor/reimbursement practices and regulations that may impact patients plan of care and confers with care coordinators and social workers to prioritize placement requests
- Seeks opportunities to identify selfdevelopment needs and takes appropriate action. Ensures own career discussions occur with appropriate management. Completes and updates the My Development Plan on an ongoing basis
This job description is not intended to be allinclusive; the employee will also perform other reasonably related business/job duties as assigned. Houston Methodist reserves the right to revise job duties and responsibilities as the need arises.
- High School diploma or equivalent education (examples include: GED verification of homeschool equivalency partial or full completion of postsecondary education etc.)
- Associate degree preferred
WORK EXPERIENCE
- Two years of experience in any of the following: service recovery insurance verification working with patient information having patient contact and/or general health care coordination responsibilities within a healthcare environment
- Previous experience in hospital setting and/or Case Management
- N/A
- Demonstrates the skills and competencies necessary to safely perform the assigned job determined through ongoing skills competency assessments and performance evaluations
- Sufficient proficiency in speaking reading and writing the English language necessary to perform the essential functions of this job especially with regard to activities impacting patient or employee safety or security
- Ability to effectively communicate with patients physicians family members and coworkers in a manner consistent with a customer service focus and application of positive language principles
- Some knowledge of community resources
- Must be able to operate within a Microsoft Office environment. Proficiency in MS Outlook and MS Word/Excel knowledge of Medical Terminology
- Excellent telephone oral and written communication skills time management and prioritization skills
- Able to learn new skills effectively
- Ability to work independently while collaborating with other team members and exercise sound judgment in interactions with physicians payors and patients and their families
- Strong organizational and problemsolving skills
SUPPLEMENTAL REQUIREMENTS
WORK ATTIRE
- Uniform No
- Scrubs No
- Business professional Yes
- Other (department approved) No
ONCALL*
*Note that employees may be required to be oncall during emergencies (ie. DIsaster Severe Weather Events etc) regardless of selection below.
- On Call* No
TRAVEL**
**Travel specifications may vary by department**
- May require travel within the Houston Metropolitan area No
- May require travel outside Houston Metropolitan area No
Company Profile:
Houston Methodist The Woodlands Hospital opened in June 2017 as the eighth hospital in the Houston Methodist system. This 267bed 725000squarefoot fullservice acutecare hospital offers many of the same services as our flagship hospital in the Texas Medical Center. Also on the beautiful hospital campus located at the intersection of Interstate 45 and Texas State Highway 242 are two medical office buildings which include a Breast Care Center; Cancer Center; infusion center; heart and vascular services; neurology; orthopedics and sports medicine; rehabilitation services; wellness services; an outpatient laboratory; and several other multispecialty physician practices. In January 2022 Houston Methodist The Woodlands opened Healing Tower a $250 million expansion project that added 106 beds focused on medicalsurgical and womens services and provided nine operating rooms. The project also included the expansion of the endoscopy center emergency department and diagnostic imaging department with an enhanced neurodiagnostic and interventional center.
Houston Methodist is an Equal Opportunity Employer.
Equal employment opportunity is a sound and just concept to which Houston Methodist is firmly bound. Houston Methodist will not engage in discrimination against or harassment of any person employed or seeking employment with Houston Methodist on the basis of race color religion sex sexual orientation gender identity national origin age disability status as a protected veteran or other characteristics protected by law. VEVRAA Federal Contractor priority referral Protected Veterans requested.
Employment Type
Full Time
