Integrated Case Management Specialist

Hackensack Meridian Health; Hackensack (NJ); On-site; USD 25,000 - 35,000; Full time

Job summary

Hackensack Meridian Health is seeking an Integrated Case Management Specialist to support insurance management, pre-certs, and discharge coordination. You will handle appeals, denials, and communications with payors while supporting Care Coordinators.

You will use EPIC to retrieve information, assist with Medicaid appointments, and coordinate community resources. A background in healthcare and strong communication skills are essential.

Qualifications

• High School diploma, GED, or GED equivalent.
• Experience in the healthcare industry.
• Effective written, oral, and interpersonal communications skills.
• Proficient computer, word-processing and Excel skills.
• Ability to learn EPIC and INDICIA
• Educated in discharge needs of patients.
• Strong time management and priority-setting skills.
• Ability to work independently and as a team member.
• Self-directed with initiative to solve problems.

Responsibilities

• Review daily admission data with the Care Coordinator to verify insurance coverage, pre-certs, and authorized days.
• Contact admitting to obtain missing/incorrect authorization information.
• Daily log reconciliation and data entry in EPIC.
• Retrieve information for Physician Advisors as needed.
• Assist in DNFB reports to identify outlier/approved days and releases.
• Enter discharge and demographic data in EPIC; manage denials.
• Coordinate activities with payors and arrange authorizations when needed.
• Answer phones for social work and case management; perform clerical support tasks.

Skills

Healthcare experience

EPIC

Excel

Communication skills

Teamwork

Education

GED or High School diploma

BSW/CSW preferred

Tools

EPIC

INDICIA

Job description

Our team members are the heart of what makes us better.

At Hackensack Meridian Health we help our patients live better, healthier lives — and we help one another to succeed. With a culture rooted in connection and collaboration, our employees are team members. Here, competitive benefits are just the beginning. It’s also about how we support one another and how we show up for our community.

Together, we keep getting better - advancing our mission to transform healthcare and serve as a leader of positive change.

The Integrated Case Management Specialist performs selected services and functions related to insurance management with various payors, ortho calls, payer communications and support of the Care Coordinators. Prepares required Appeals and Denial information for processing and follows up on receipt of communication including Livanta appeal management process. Oversees the sorting and distribution of mail in the department. Answers case management and social work phones. Medicaid appointment, all discharge functions for the Care Coordinators, including seventy hour discharge report and providing patients with the IM Letter from Medicare prior to discharge.

A day in the life of a Integrated Case Management Specialist at Hackensack Meridian Health includes

• In collaboration with the Care Coordinator, reviews daily admission data to verify inpatient insurance coverage, pre-certs, authorized days, and reviews needed. Alerts the CC to potential problems with any of the above.
• If the authorization/precert information is missing or incorrect, the Case Management Specialist will contact admitting to obtain the necessary and accurate information.
• Daily log reconciliation.
• Utilizes EPIC computer software to retrieve necessary information, inclusive of free text fields, to support the case management, utilization review process.
• Retrieves information for the Physician Advisors as needed.
• Works the DNFB report to determine outlier days, approved days, etc., and releases accounts as appropriate.
• Checks admission and discharge dates.
• Enters LAD into EPIC.
• Keeps Utilization Review RN current on updates needed for payors.
• Enters all documentation into EPIC systems for denials/ lower level of cares.
• Contacts insurance company for benefit coverage and obtains authorizations when needed.
• Answers all phones, including social work and case management office lines.
• Performs office support services to facilitate efficient running of the department, i.e., phone call management, messages, mail/correspondence, ordering supplies and assisting the screeners from other facilities, 72 hour discharge report, weekend discharge report.
• Assists CC through telephone, personal or written communications. Also serves as an interpreter for the department if certified by HUMC. 15. Participates in quality improvement efforts for the department to assist in improving work efficiency, and to help meet the goals of the department, files the required documents.
• Performs other clerical support duties as delegated by the Administrator, Manager(s), CC
• As requested by CC schedules transport from HUMC to discharge destination, depending upon insurance. 18. As requested by CC will locate beds for discharge to a facility and fax referral.
• As requested will order DME for patients.
• As requested will refer to community Resources.
• As requested will provide patient/ family with IM from Medicare Letter.
• As requested will arrange Medicaid appointments.
• As requested will arrange follow up appointments at MD`s office and/ or clinics.
• As requested faxes medications, once received from CC to a particular pharmacy.
• As requested participates in hospital to hospital transfers, and/or transfers back to facilities.
• As requested faxes referrals to home care, dialysis subacute rehab, acute rehab, or other facilities.
• As requested faxes applications for Medication assistance.
• Performs initial and psycho/social assessments as needed.
• All other duties as assigned.

Education, Knowledge, Skills and Abilities Required

• High School diploma, general equivalency diploma (GED), and/or GED equivalent programs.
• Experience in the healthcare industry.
• Effective written, oral, and interpersonal communications skills.
• Proficient computer, word-processing and Excel spreadsheet skills.
• Ability to learn new computer systems, i.e. EPIC, INDICIA.
• Educated in the unique clinical and discharge needs of the patients.
• Strong time management and priority-setting skills.
• Ability to work independently and as a team member.
• Self-directed with the ability to take the initiative to solve problems.

Education, Knowledge, Skills and Abilities Preferred

• 1 year recent experience in a hospital or medical setting preferred.
• BSW/CSW preferred.

Minimum rate of $21.73 Hourly

HMH is committed to pay equity and transparency for our team members. The posted rate of pay in this job posting is a reasonable good faith estimate of the minimum base pay for this role at the time of posting in accordance with the New Jersey Pay Transparency Act and does not reflect the full value of our market-competitive total rewards package.

The starting rate of pay is provided for informational purposes only and is not a guarantee of a specific offer. Posted hourly rates may be stated as an annual salary in the offer and posted annual salaries may be stated as an hourly rate in the offer, depending on the level and nature of the job duties and credentials of the candidate. The base compensation determined at the time of the offer may be different than the posted rate of pay based on a number of non-discriminatory factors, including but not limited to

Labor Market Data Compensation is benchmarked against market data to ensure competitiveness.

Experience Years of relevant work experience.

Education and Certifications Level of education attained, including specialized certifications, credentials, completed apprenticeship programs or advanced training.

Skills Demonstrated proficiency in relevant skills and competencies.

Geographic Location Cost of living and market rates for the specific location.

Internal Equity Compensation is determined in a manner consistent with compensation ranges for similar roles within the organization.

Budget and Grant Funding Departmental budgets and any grant funding associated with the job position may impact the pay that can be offered.

Some jobs may also be eligible for performance-based incentives, bonuses, or commissions not reflected in the starting rate. Certain positions may also be eligible for shift differentials for work performed on evening, night, or weekend shifts.

In addition to our compensation for full-time and part-time (20+ hours/week) job positions, HMH offers a comprehensive benefits package, including health, dental, vision, paid leave, tuition reimbursement, and retirement benefits.