Care Management Resource Coordinator New! Case Management | Full-Time | Phoenix ...Read More Qu[...]

Phoenix Children's Hospital, Inc.; Phoenix (AZ); On-site; USD 35,000 - 50,000; Full time

Job summary

Phoenix Children's Hospital, Inc. is looking for support staff to assist with Social Work and Utilization Management activities. Candidates will engage in patient care logistics, manage hospital procedures, and ensure effective communication within healthcare teams.

This role demands excellent communication skills and requires a minimum of three years in healthcare. A high school diploma is a must, with higher education preferred.

Qualifications

• Three years of experience in health care as a nursing student, medical assistant, or related field.
• Experience with medical terminology.

Responsibilities

• Receives and fulfills requests for transportation vouchers and amenities.
• Supports Utilization Management activities and case management.
• Conducts post-discharge follow-up calls to patients.

Skills

Excellent communication skills

Effective critical thinking skills

Moderate computer skills

Effective decision-making/problem-solving skills

Bilingual (Spanish)

Education

High school diploma or equivalent

Associate’s or Bachelor’s degree in a related field

Job description

Responsibilities

• Supports Social Work activities:
  • Receives, evaluates and fulfills requests for local transportation vouchers, meal cards and other amenities.
  • Receives, evaluates and fulfills requests for out-of-area transportation, including air travel and lodging.
  • Receives, evaluates and facilitates requests for Ronald McDonald House services.
  • Appropriately escalates requests that do not meet criteria to responsible social worker or manager.
  • Faxes medical records and other documents, as directed by social workers, to law enforcement agencies, government agencies, and other healthcare organizations.
  • Assists patients-families to schedule appointments with various agencies.
  • Assists patients with documents or letters needed for FMLA, border crossing applications, school activity letters, and other social needs related to their care.
  • Schedules care conferences.
  • Maintains complete and accurate patient resource materials, including primary care providers by payer source (including free and low-cost clinics), WIC information, housing resources, and other social services. Provides resource information as requested by patients-families, social workers, and care team members.
  • Obtains car seats.
  • Answers Social Work phone line and retrieves voice mail messages. Takes appropriate and authorized actions or routes to Social Worker.
• Supports Utilization Management activities:
  • Reviews and organizes materials faxed to department, prepares daily reports and other materials, and distributes/directs to appropriate Utilization Management nurse.
  • Receives and reviews third-party payer requests for concurrent review and notifications of denied hospital days; routes to appropriate Utilization Management nurse.
  • Answers Utilization Management/Case Management phone line and retrieves voice mail messages. Takes appropriate and authorized actions or routes to Utilization Management or Case Management nurse.
  • Scans and uploads into the EMR and/or financial applications authorization and requests for concurrent and retrospective third-party utilization reviews.
  • Enters authorization information in financial applications.
  • Maintains reports of denied hospitalizations and hospital days, pending appeals, outcomes of appeals, and reasons for delayed discharges.
  • Identifies, monitors and communicates trends with third-party payer denials of authorization requests to appropriate manager.
• Supports Case Management activities:
  • Identifies and provides appeal rights letters to in-house Tricare and Medicare patients, and documents in log and the medical record.
  • Verifies address and other demographic information for purposes of coordinating delivery of home needs and communication with families post-discharge.
  • Identifies current home care service providers, and documents in the medical record for the Case Manager.
  • Determines third-party payer coverage/benefits and obtains insurance pre-authorization for home health services, post-discharge medications, rehabilitative therapy, durable medical equipment, medical transportation, and other post-discharge needs.
  • Facilitates arrangements for post-discharge needs, including scheduling services and coordinating availability of equipment/supplies and medications, under the direction of the Case Manager. Provides patient-family, Case Manager and clinical care team members with timely and accurate status of coordination of services, and documents information in the medical record. Appropriately escalates to responsible Case Manager and other care team members any situation/issue that poses a barrier to providing for complete and timely post-discharge needs.
  • Monitors and determines bed availability at rehab facilities, other acute care hospitals, long-term care facilities, mental health facilities and other organizations. Determines third-party coverage/benefits and obtains authorization for transfer to other facilities; faxes medical records and coordinates transfer of patient under direction of the Case Manager. Appropriately escalates to responsible Case Manager and other care team members any situation/issue that poses a barrier to on-schedule transfer. Documents status and actions in the medical record.
  • Coordinates peer-to-peer medical records with third-party payers and Phoenix Children's providers.
  • Conducts post-discharge follow-up calls to patients, and appropriately notifies Case Managers when intervention is needed.
• Provides Care Management Department support:
  • Understands and focuses on Hospital Revenue Cycle key performance indicators.
  • Works collaboratively with team members and performs clerical cross-coverage where needed.
  • Responds to emails within 24 hours.
  • Communicates clearly with all internal and external customers.
  • Provides excellent service routinely in interactions with all customers, i.e. coworkers, patients, visitors, physicians, volunteers, etc.
  • Performs miscellaneous job-related duties as requested.

Qualifications

Education

• High school diploma or equivalent. (Required)
• Associate’s or Bachelor’s degree in a related field. (Preferred)

Experience

• Three years of experience in health care as a nursing student, medical assistant, home care coordinator, health unit coordinator, patient care technician, or related field. (Required)
• Experience with medical terminology. (Preferred)

Special Skills

• Excellent communication skills, both verbal and written. (Required)
• Effective critical thinking skills and ability to anticipate patient discharge needs. (Required)
• Moderate computer skills. (Required)
• Effective decision-making/problem-solving skills, demonstration of creativity in problem-solving. (Required)
• Bilingual (Spanish). (Preferred)

Additional Requirements

• Current BLS Certification from the American Heart Association. (Preferred)
• Valid AZ Department of Public Safety (DPS) Fingerprint Clearance Card. (Required)

Physical Requirements & Occupational Exposure/Risk Potential

1. Physical Requirement – Feeling (sensing textures and temperatures) – Occasionally

2. Physical Requirement – Fine Motor Skills (pinching, gripping, etc) – Occasionally

3. Physical Requirement – Hearing – Constantly

4. Physical Requirement – Pushing/pulling – Occasionally

5. Physical Requirement – Reaching – Occasionally

6. Physical Requirement – Sitting – Constantly

7. Physical Requirement – Standing – Constantly

8. Physical Requirement – Talking – Constantly

9. Physical Requirement – Tasting/smelling – Occasionally

10. Physical Requirement – Walking – Constantly

11. Physical Requirement – Near Vision – Constantly

12. Physical Requirement – Far Vision – Constantly

13. Physical Requirement – Color Discrimination – Occasionally

14. Physical Requirement – Use of keyboard, mouse and/or computer equipment – Constantly

15. Physical Requirement – Lift up to 35 pounds without assistance – Occasionally

16. Physical Requirement – Lift more than 35 pounds without assistance – Occasionally

17. Occupational Exposure/Risk Potential – Inside office environment – Applicable

18. Occupational Exposure/Risk Potential – Confined areas – Applicable

19. Occupational Exposure/Risk Potential – Extreme noise levels – Applicable

20. Occupational Exposure/Risk Potential – Airborne communicable diseases – Applicable

21. Occupational Exposure/Risk Potential – Bloodborne pathogens or bodily fluid – Applicable

22. Occupational Exposure/Risk Potential – Fumes or airborne particles – Applicable

23. Occupational Exposure/Risk Potential – Hazardous materials exposure – Applicable

24. Occupational Exposure/Risk Potential – Radiation exposure – Applicable

25. Occupational Exposure/Risk Potential – Toxic or caustic chemicals – Applicable