Case Mgmt Asst at SONOMA SPECIALTY HOSPITAL – Sebastopol, California

Position Title: Case Management Assistant

Department: Case Management

Reports to: Director of Case Management

FSLA Status: Non-Exempt

Job Summary:

Provides clerical and administrative support to the Case Management team to facilitate care coordination, discharge planning, and utilization review. This may include but is not limited to: Tracking dates that concurrent reviews are due to third party payors; Obtaining updated clinical information from the EMR/Chart or the managed care forms filled out by case managers, and faxing to third party payors; Obtaining fax confirmation and making follow up calls to verify concurrent review information was received; Obtaining authorizations and documenting these with accuracy in the HMS financial system. After receiving training, may assist with issuing the Medicare Important Message. Assists with initial post discharge referrals and makes follow-up calls to providers regarding referrals and acceptance. Assists with arrangement of post-acute care services such as Home Health, Durable Medical Equipment, Outpatient Dialysis, Outpatient Infusion and Wound Care Centers, and post discharge transportation. Assists with preparation and completeness of discharge packets that accompany patients to Skilled Nursing, Subacute, and Acute Rehab Facilities. Assists in arranging post discharge physician appointments with primary care physician and specialist. May conduct post discharge calls to patients and providers and refer to appropriate disciplines if additional follow-up is needed.

Essential Function and Responsibilities:

• Attend Case Management department daily Huddle and gather information for tasks of the day to assist the Case Managers.
• Follow prioritization instructions from DCM or designated Case Manager in the DCM’s absence. Assist with discharge preparations and arrangements for current daily and future discharges as requested. Delivers Important Message to Medicare following training.
• Assist with initial post discharge referrals and make follow up calls to providers regarding referrals and acceptance. Arrangement of post-acute care services such as Home Health, Durable Medical Equipment, Outpatient Dialysis, Outpatient Infusion and Wound Care Centers, and post discharge transportation. Assist with preparation and completeness of discharge packets that accompany patients to Skilled Nursing, Subacute, and Acute Rehab Facilities.
• Assist in arranging post discharge physician appointments with primary care physicians and specialists.
• Assist patients with Medicaid applications as requested by patients, families, and Case Managers. Review daily concurrent review list for reviews and authorizations due to be sent to third party payors and organize by time zone.
• Obtain clinical information as directed by the Case Manager from the EMR or the Managed Care Update Form completed by the Case Manager and fax to third party payors. Follow up with fax confirmation and phone calls to payors to obtain authorizations verbally or written.
• Accurately document all continued stay activities and communication both written and verbal in HMS.
• Ensure any written correspondence received by or sent to payor is scanned into HMS.
• Answers telephone, records messages.
• Arrange meetings and in-services, send invitations, distribute materials, and takes minutes as requested.
• Participates in data collection and tracking projects. Receives and files Vendor and Community Agency Information materials.
• Gathers, sorts, and prepares mail for Case Management department.
• Organizes and orders office supplies.
• Compliance: Knowledge of and adherence to all Case Management and Hospital Wide Policies and Procedures.
• Maintains strict Patient Confidentiality in all communication internally and externally.
• Develops a working knowledge of federal and state regulations pertaining to Case Management.
• Maintain excellent working relationships with co-workers, health care professionals and other health related facilities and organizations as appropriate.
• Promote Organization philosophy, mission and objectives within and to patients and customers outside the hospital.
• Demonstrates ability to prioritize tasks/responsibilities and complete duties within allotted time.
• Willingness to seek out new methods and principles and be willing to incorporate them into existing practices.
• Demonstrates and understands the importance of and respect for the rights, dignity, and individuality of each patient in all interactions.
• Always demonstrates honesty and integrity in the care and use of patient and hospital property. Demonstrates respect for co-workers and responds to needs of patients by complying with hospital policies.
• Demonstrates satisfactory level of interpersonal skills to interact and deal tactfully with facility staff, Administration, patients, families, customers, vendors, and government agencies.
• Ability to carry out essential functions of this position with or without reasonable accommodation.
• Access continuing education opportunities appropriate to responsibilities.
• Appropriately accesses the resources of the company’s corporate offices for consultation and support. Routinely shares professional knowledge with staff, managers and hospital personnel.
• Attend and participate in facility meetings.
• Knowledge of emergency and disaster procedures of the facility.
• Reports suspected violations of policies , federal/state regulations, and/or confidentiality to Director Case Management, CEO, Director of Quality.
• Participate in hospital wide safety program identifying risks to patient safety and reducing healthcare errors.
• Participates in relevant in-service training sessions.
• Perform other duties as assigned.
• Promotes and protects patients’ rights; treats patients with dignity and respect; reports suspected abuse or neglect.
• Demonstrates willingness to try new tasks; generates new ideas for change; evaluates and recognizes priorities; communicates and models organizational values; fosters high performance
• Apply performance improvement methods and techniques; assist in data collection; identifies processes for improvement in daily work; and participate in new employee orientation.
• Demonstrates understanding of fire and emergency procedures; participates in fire and disaster drills; demonstrates understanding of safety and security procedures; applies safety and security precautions; demonstrates understanding of hazardous materials plan; demonstrates proper use of equipment.
• Applies hand-washing principles during daily work; demonstrates understanding of isolation precautions; demonstrates understanding of the process for identifying and handling infectious waste; maintains personal hygiene; recognizes signs and symptoms of infection and complies with the employee health program; complies with OSHA standards in the workplace; and demonstrates understanding of cross contamination.
• Comply with applicable health screenings. Information Management Enters or records data timely and accurately; protects confidentiality of patient information; protects data against loss or destruction; reports suspected violation of security/confidentiality issues timely.

Supervisory Requirements (if applicable): None

Education, Training and Licenses Required:

• High School Graduate/Equivalent
• One-year experience in acute care (Preferred)
• Administrative: 1 year (Preferred)
• Case management: 1 year (Preferred)

Skills, Abilities, and Knowledge:

• Strong Communication skills
• High level computer skills, Word/Excel knowledge required.
• Medical terminology.
• Proficient in oral and written communication skills.