Description
Summary
Job Summary: Supports the case management team with the underlying objective of enhancing the quality of clinical outcomes and patient satisfaction while providing timely and accurate information for the hospital. Assists case management by completing various tasks such as confirmation of the accuracy of demographic information, admission status, level of care, payer source eligibility, continued stay, and potential discharge plans to include foreseeable barriers. May be required to assist with ED/LDRP visits and may also provide direct patient care or interventions designed to promote health, prevent disease, and address barriers to access to healthcare, as needed to support case management. Responsible for running reports as scheduled.
Essential Duties and Responsibilities: Promotes the mission, vision, and values of the organization. Adheres to, ‘Simply the Best', Standard of Performance. Supports the interdisciplinary and case management teams with the underlying objective of enhancing the quality of clinical outcomes and patient satisfaction while providing timely and accurate information for the hospital. Daily Census Reconciliation: Admission order verification/clarification, insurance eligibility checks, record management, ensuring the accuracy of demographic information. Precertification verification: verify pre-certification with appropriate code, pre-cert approval/confirmation of no approval required. Delegation of recommended corrections during the reconciliation process. Monitor status changes: Coordination with IDT to include admissions that occur during business hours. High-risk follow-up calls: Calls, notification of IDT, and pertinent patient support persons. Reports: daily, weekly, monthly, annual ex.: IMM/MOON (complete process), GLOS vs LOS, LACE, HCAHPS, <30day readmission rate, UR case review, etc. Maintains working knowledge of Medicare, Medicaid, and commercial insurance companies. Participates in team meetings that foster interdepartmental collaboration with pertinent members of the patient's care team including but not limited to multidisciplinary meetings (care conference, Pratt County Multi-Disciplinary, Resource Council) and case management meetings. Ensures a level of quality of care is maintained or surpassed by collecting quality data indicators, and variance data and reporting the data to the appropriate department; reports and identifies data that indicates potential areas for improvement of care and services provided within the system. Facility/Agency resource management. Other duties may be assigned. Professional Requirements: Complete annual education requirements. Always maintain patient confidentiality. Maintain regulatory requirements, including state, federal, and local regulations. Comply with all organizational policies and standards regarding ethical business practices. Communicate the mission, ethics, and goals of the organization. Attend regular staff meetings and in-services. Knowledge/Skills/Abilities: Knowledge of nursing services and insurance coverage preferred. Strong organizational and interpersonal skills. Ability to determine appropriate course of action in more complex situations. Ability to work independently, exercise creativity, be attentive to detail, and maintain a positive attitude. Ability to manage multiple and simultaneous responsibilities and to prioritize scheduling of work. Ability to maintain confidentiality of all medical, financial, and legal information. Ability to complete work assignments accurately and promptly. Ability to handle difficult situations involving patients, physicians, or others in a professional manner.
Education/Experience: Licensed Certified Nurse Assistant in the State of Kansas. BLS required.
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