Manager - Intake Operations

Prime Healthcare; Rosemont (IL); On-site; USD 84,000 - 113,000; Full time

Job summary

Prime Healthcare is seeking an experienced LTACH Case Manager for Holy Family Medical Center in Des Plaines, IL. You will lead LTACH admissions, perform screenings, and coordinate transitions for patients requiring higher levels of care.

The role requires 2+ years in hospital settings, knowledge of Utilization Review and InterQual/Milliman criteria, and collaboration with physicians, payors, and care teams to secure timely authorizations and patient transfers.

Qualifications

• Medical, dental, PA, or nursing graduate required.
• Two years of hospital setting experience.
• 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

• Serve as the operational lead for LTACH admissions and referral management.
• Screens and conducts clinical reviews of patients for LTACH appropriateness.
• Identifies in-system patients who may benefit from LTACH level of care and coordinates follow-up for ongoing management.
• Collaborates with physicians, case managers, hospital leadership, and clinical liaisons to coordinate patient transitions to LTACH.
• Works with managed care payors to obtain prior authorization and facilitate timely transfers when appropriate.
• Completes intake processes including information about hospital services and programs; coordinates tours, referrals, and prior authorizations.
• Maintains updated referral logs and accurate registration, admission, and discharge data; supports data statistics for the department.
• Performs other duties as assigned.

Skills

Utilization Review/Management

InterQual criteria

Milliman criteria

Healthcare management

Education

Medical Graduate

Dental Graduate

PA

Nursing Graduate

Tools

InterQual

Milliman

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