Care Management Specialist

J  o  b    D  e  s  c  r  i  p  t  i  o  n

          Joy                         Care                      Competence                    Respect

Position Summary

The Care Management Specialist, in collaboration with the Care Manager, assists in coordinating the utilization review and discharge planning tasks. They are responsible for organizing and overseeing the administrative aspects of utilization review and discharge planning and other assigned duties within the Care Management department.

High School Diploma or GED is preferred.

Experience within a health system is preferred.

Medical Terminology knowledge is preferred.

1-2 years of clerical experience is required.

Certified Nursing Assistant or other health certification is preferred.

Able to analyze and utilize reports and data points to drive outcomes such as number of authorizations for service.

Strong verbal communication and listening skills as well as excellent team building and collaborative skills.

Demonstrates time management and priority setting skills with the ability to drive multiple tasks to completion within strict deadlines.

Ability to follow regulatory guidelines and provide excellent customer service.

High proficiency in Microsoft Office products and ability to navigate electronic medical record.

Demonstrated problem solving skills.

Works with Care Management team, registered nurses, social workers, physicians, colleagues, and external payors, as well as community liaisons. Uses portals for utilization review and discharge planning.

Navigates the authorization for stay and discharge needs identified by the case manager.

Completes reports and navigates portals and communication tools to secure post-acute or inpatient authorization for services.

In discharge planning, works with the case manager to communicate with patient and family and navigate the choice of post-acute resources. Shares the needed information to authorize resources and follow up on coordinating the patient to the discharge destination. 

In utilization review, coordinates efforts to secure authorization for inpatient stay. Organizes peer to peer, when needed.

Communicates and collaborates with the interdisciplinary team through verbal and written communication.

Adheres to confidentiality policies specific to communication, record keeping, and coordination of services.  Documents in all areas of discharge planning to determine patient status in the discharge process. 

Interacts with the patients, families, and/or significant others to expedite the discharge process.

Reviews each case to ensure all documentation is sent over to payor or post-acute service selection.

Reviews each patient before and upon discharge to determine if authorization for stay or follow up is needed.

Coordinates peer to peer to address any potential medical necessity denials or post-acute denials to manage and discharge patient.

Develops a fluid communication mechanism with payors.

Possess the information, skill, and understanding of the work to be performed.  Actively participates in continuing education opportunities and maintains certifications, licensure as appropriate.

Abides by all safety requirements including demonstrating proper hand hygiene and wearing of Personal Protective Equipment (PPE), if applicable. 

Complies with all standards, policies and procedures including dress code, attendance and punctuality.  Attends required in-services and meetings and completes all mandatory competencies by deadline. Commits to keeping all patient, student or colleague information confidential and maintains ongoing communication and collaboration with team members. 

The purpose of this job description is to provide a summary of the major responsibilities performed by colleagues in this position. Colleagues may be requested to perform tasks other than those specifically presented in this job description.  Variances in job duties performed may exist between facilities, and colleagues may perform other related duties as assigned to meet the needs of the organization.

PHYSICAL, MENTAL AND ENVIRONMENTAL REQUIREMENTS

Physical, Mental and Environmental Requirements Category:

Administrative

Standing

X

Walking

X

Sitting

X

Lifting

X

20 lbs.

Carrying

X

20 lbs.

Pushing

X

20 lbs.

Pulling

X

20 lbs.

Climbing

X

Balancing

X

Stooping

X

Kneeling

X

Crouching

X

Crawling

X

Reaching

X

Use of Hands/Dexterity

X

Talking

X

Hearing

X

Eye/Hand/Foot Coordination

X

Extreme Cold

X

Extreme Heat

X

Humid

X

Wet

X

Noise

X

Hazards

X

Temperature Change

X

Atmospheric Conditions

X

Vibration

X

Other