Manager - Intake Operations

Prime Healthcare; Des Plaines, Northern (IL, KY); Hybrid; USD 84,000 - 113,000; Full time

Benefits offered by this job

401K plan

Medical, dental & vision coverage

Tuition reimbursement

Job summary

Prime Healthcare's Holy Family Medical Center in Des Plaines, IL seeks a full-time LTACH admissions and referral manager within Case Management. This role screens patients for LTACH suitability, coordinates transitions with physicians and care teams, and ensures timely prior authorizations for transfers.

Responsibilities include intake processing, referral tracking, and maintaining accurate data. Experience in Utilization Review and understanding InterQual criteria are preferred.

Qualifications

• Medical or allied health graduate required.
• 2 years of experience in a hospital setting.
• Utilization Review/Management experience preferred.
• Knowledge of InterQual and Milliman criteria preferred.
• Healthcare management experience preferred.
• Knowledge of reimbursement and managed care structures preferred.

Responsibilities

• Lead LTACH admissions and referral management operations.
• Screen and review patients for LTACH appropriateness and level of care.
• Coordinate patient transitions with physicians, case managers and hospital leadership.
• Obtain prior authorizations and facilitate timely transfers with managed care payors.
• Manage referrals, intake, registrations, and discharge data with daily logs.

Skills

Utilization Review

Hospital setting experience

InterQual/Milliman knowledge

Education

Medical Graduate

Dental Graduate

PA

Nursing Graduate

Tools

InterQual criteria

Job description

Overview

Department: Case Management

Schedule: Full-time

Facility: Holy Family Medical Center

Location: Des Plaines, IL

Responsibilities

Serves as the operational lead for LTACH admissions andreferral management. Conductsscreening and clinical reviews of patients for LTACHappropriateness.Identifiesin-system patients who maybenefitfrom LTACHlevel of care andfacilitatesfollow-up toensurecare providers are aware of this option for continued patient management.Collaborate with physicians, case managers, hospital leadership,andclinical liaisons, tocoordinatepatienttransition to LTACH.Works closelywith managed care payors to obtain prior authorization and tofacilitatetimelytransferwhen patients are medicallyappropriate.

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.

Qualifications

EDUCATION, EXPERIENCE, TRAINING

• Medical Graduate, Dental Graduate, PA, or Nursing Graduate required.
• Two yearsof experience ina hospitalsetting.
• Experience in Utilization Review/Management preferred.
• Knowledge of InterQual and Millimanand orInterQualcriteriapreferred.
• Healthcare management experience preferred.
• Knowledgeof reimbursement and managed care structurespreferred.

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