Manager - Intake Operations

Holy Family Medical Center; Des Plaines (IL); On-site; USD 84,000 - 113,000; Full time

Job summary

Holy Family Medical Center in Des Plaines, IL is seeking an experienced LTACH admissions coordinator. You will lead admissions operations, screen patients for LTACH appropriateness, and coordinate referrals and transitions with physicians, case managers, and leadership to ensure timely patient care.

The role requires hospital experience and knowledge of utilization review, InterQual criteria, and managed care processes.

Qualifications

• Two years of experience in a hospital setting.
• Experience in Utilization Review/Management preferred.
• Knowledge of InterQual and Milliman criteria preferred.
• Healthcare management experience preferred.
• Knowledge of reimbursement and managed care structures preferred.

Responsibilities

• Operate as the LTACH admissions and referrals lead.
• Screen patients for LTACH appropriateness and conduct clinical reviews.
• Coordinate patient transitions to LTACH with clinicians and leadership.
• Collaborate with payors to obtain prior authorizations and timely transfers.
• Complete intake, referrals, and prior authorizations workflows.
• Maintain daily referral log and admission data; ensure accurate records.
• Generate department statistics related to referrals and admissions.

Skills

Utilization Review

InterQual knowledge

Managed care knowledge

Prior authorization experience

Education

Medical Graduate

Dental Graduate

PA

Nursing Graduate

Job description

Responsibilities

Serves as the operational lead for LTACH admissions and referral management. Conducts screening and clinical reviews of patients for LTACH appropriateness. Identifies in-system patients who may benefit from LTACH level of care and facilitates follow-up to ensure care providers are aware of this option for continued patient management. Collaborate with physicians, case managers, hospital leadership, and clinical liaisons, to coordinate patient transition to LTACH. Works closely with managed care payors to obtain prior authorization and to facilitate timely transfer when patients are medically appropriate. Completes intake processes including providing information about hospital services and programs. Coordinates tours, referrals, and prior authorizations. Communicates directly with managed care providers to coordinate peer to peer discussions and follow-up for cases that are denied. Retrieves referrals, initiates a pre-admission encounter, and assigns each referral to appropriate clinical liaisons. Maintains updated information for each referral on the daily referral log. Facilitate admissions with clinical leadership team, finance department, and case management. Assure authorizations are accurate or updated and provide corresponding insurance information to the business office, case management, and physicians. Responsible for entering and maintaining accurate registration, admission, and discharge data. Maintains statistics related to referral and admission volumes as well as other departmental data. Responsible for other duties as assigned.

Overview

Department: Case Management

Schedule: Full-time

Facility: Holy Family Medical Center

Location: Des Plaines, IL

Qualifications

• Medical Graduate, Dental Graduate, PA, or Nursing Graduate required.
• Two years of experience in a hospital setting.
• Experience in Utilization Review/Management preferred.
• Knowledge of InterQual and Milliman and or InterQual criteria preferred.
• Healthcare management experience preferred.
• Knowledge of reimbursement and managed care structures preferred.

Pay Transparency

Holy Family Medical Center offers competitive compensation and a comprehensive benefits package that provides employees the flexibility to tailor benefits according to their individual needs. Our Total Rewards package includes, but is not limited to, paid time off, a 401K retirement plan, medical, dental, and vision coverage, tuition reimbursement, and many more voluntary benefit options. A reasonable compensation estimate for this role, which includes estimated wages, benefits, and other forms of compensation, is $84,281.60 to $113,422.40 on an annualized basis. The exact starting compensation to be offered will be determined at the time of selecting an applicant for hire, in which a wide range of factors will be considered, including but not limited to, skillset, years of applicable experience, education, credentials and licensure.

The company is dedicated to empowering its staff with a comprehensive, competitive benefits package, allowing them the freedom to customize their benefits to fit their unique needs. Our abundant resources, programs, and voluntary options serve as a foundation for individual growth and well-being. Learn more here: https://www.primehealthcare.com/benefitsthatmattermost/

Employment Status

Full Time

Shift

Days

Equal Employment Opportunity

Company is an equal employment opportunity employer. Company prohibits discrimination against any applicant or employee based on race, color, sex, sexual orientation, gender identity, religion, national origin, age (subject to applicable law), disability, military status, genetic information or any other basis protected by applicable federal, state, or local laws. The Company also prohibits harassment of applicants or employees based on any of these protected categories. Know Your Rights: https://www.eeoc.gov/sites/default/files/2022-10/EEOC_KnowYourRights_screen_reader_10_20.pdf