Case Management Assistant/ Discharge Planner- JNE

Number of Positions In Requisition
1


Job Details
The Discharge Planner/ Case Management assistant facilitates safe, timely, and cost-effective transitions of care by coordinating all post-acute service and appointment needs for patients on the assigned unit. The discharge planner assists the transfer center to ensure timely internal and external transfers. Working collaboratively with providers, care managers, and interdisciplinary team members, the discharge planner ensures that follow-up physician, laboratory, procedural, and financial appointments are accurately scheduled and linked to appropriate orders and payor requirements. This role communicates with third-party payers to secure authorization for inpatient and post-acute services. The Discharge Planner also assesses psychosocial and environmental factors affecting recovery, provides education and referrals to community resources, and supports patients and families in coping with the transition from hospital to home or another level of care.

Job Description

Summary
Works under the direction of the Manager of Case Management and Case Manager RN to provide assistance with the utilization review process, including communicating clinical information/reviews to third party payers to ensure certification/approval of inpatient and post-hospital services. Assists with the coordination of post hospital care and service arrangements.

Job Duties

- Interacts with co-workers, visitors, and other staff consistent with the values of Jefferson.(Do not delete, move or over-write this statement)
- Negotiates with payers to obtain authorization for appropriate level of care and length of stay.
- Responsible for meeting insurer timeframes regarding review of clinical information.
- Provides prompt feedback regarding denials and other payer determinations to the Case Manager RN and Physician Advisor.
- Obtain payer authorization and coordinate identified homecare, Durable Medical Equipment (DME), transportation, infusion services and post-acute services for all identified patients.

Minimum Qualifications

- High School Diploma/GED
- 1 year Computer literate, strong knowledge of medical terminology required.
- Knowledge of the techniques and the ability to work with a variety of individuals and groups in a constructive and collaborative manner.
- Ability to manage multiple concurrent objectives, projects, groups, or activities, making effective judgments as to prioritizing and time allocation
- Answers phones in a prompt and courteous manner directing calls and messages to the appropriate individual.
- Collaborates with Business Services to ensure accuracy of patient information. Communicates updated information to all appropriate parties in a timely manner.
- Communicates with the Supervisor/CMA colleagues when experiencing capacity to work on additional cases or need assistance.
- Communicates with third party payers for verification of insurance benefits/coverage on assigned patients.
- Communicates timely, relevant and accurate information to the Case Managers and Social Workers involved in their assigned patients’ care.
- Coordinates and arranges transportation, Durable Medical Equipment and community services as directed by the Case Manager or Social Worker.
- Documents all approvals, denials, updates and other pertinent information in relevant applications.
- Effectively communicates all forms of clinical information to all payers.
- Ensures payer and customer satisfaction through effective communication and positive customer service skills at all times.
- Ensures utilization management information is submitted to relevant third party payers within the defined timeframes.
- Identifies and communicates cases requiring clinical review for the Case Manager, including timeframes for submission of reviews.
- Keeps supervisor informed of changes in workload.
- Keeps supervisor informed of Third Party Payer patterns and trends.
- Maintains confidentiality of patient information.
- Maintains routine and frequent communication with Case Managers on the status of their referral requests.
- Maintains working knowledge of agency and community resources as required.
- Notifies Case Managers of the need for utilization information.
- Obtains authorization for appropriate level of care and length of stay from third party payers.
- On a daily basis, organizes and creates a priority work list to ensure clinical reviews are completed timely. Works with Case Managers to prioritize competing requests.
- Participates in daily sessions with the Case Manager to ensure key issues are prioritized and addressed that day.
- Proactively communicates any change in payer information to Supervisor and Manager of Denial Management and Seamless Access and documents changes appropriately.
- Provides updates to the CM/UM Manager, CM or UR Nurse if there are “pending” approvals and additional clinical information is needed for the third party payer to make a determination.
- Provides prompt feedback regarding adverse determinations and denials to appropriate staff. Escalates to the Physician Advisor as necessary as per the Case Manager.
- Responsible for meeting insurer timeframes regarding utilization management information.
- Acts as a liaison between the van service and the Hospital.
- Completes check requests for monthly department invoices.
- Directs mail and maintains inventory of supplies.
- Maintains resource file; keeps staff informed of changes/updated resource information.
- Obtains patient signatures on the Important Message from Medicare within 48 hours of patient discharge.
- Screens incoming consults (inpatient or E.R.) and forward to appropriate Case Manager or Social Worker.
- When covering the front desk, greet visitors, ascertains the nature of business and refers patients/visitors to the appropriate staff based on established guidelines.

Work Shift
Workday Day (United States of America)

Worker Sub Type
Regular

Employee Entity
Thomas Jefferson University
Primary Location Address
10800 Knights Road, Philadelphia, Pennsylvania, United States of America

Nationally ranked, Jefferson, which is principally located in the greater Philadelphia region, Lehigh Valley and Northeastern Pennsylvania and southern New Jersey, is reimagining health care and higher education to create unparalleled value. Jefferson is more than 65,000 people strong, dedicated to providing the highest-quality, compassionate clinical care for patients; making our communities healthier and stronger; preparing tomorrow's professional leaders for 21st-century careers; and creating new knowledge through basic/programmatic, clinical and applied research. Thomas Jefferson University , home of Sidney Kimmel Medical College, Jefferson College of Nursing, and the Kanbar College of Design, Engineering and Commerce, dates back to 1824 and today comprises 10 colleges and three schools offering 200+ undergraduate and graduate programs to more than 8,300 students. Jefferson Health , nationally ranked as one of the top 15 not-for-profit health care systems in the country and the largest provider in the Philadelphia and Lehigh Valley areas, serves patients through millions of encounters each year at 32 hospitals campuses and more than 700 outpatient and urgent care locations throughout the region. Jefferson Health Plans is a not-for-profit managed health care organization providing a broad range of health coverage options in Pennsylvania and New Jersey for more than 35 years.

Jefferson is committed to providing equal educa­tional and employment opportunities for all persons without regard to age, race, color, religion, creed, sexual orientation, gender, gender identity, marital status, pregnancy, national origin, ancestry, citizenship, military status, veteran status, handicap or disability or any other protected group or status.

Benefits

Jefferson offers a comprehensive package of benefits for full-time and part-time colleagues, including medical (including prescription), supplemental insurance, dental, vision, life and AD&D insurance, short- and long-term disability, flexible spending accounts, retirement plans, tuition assistance, as well as voluntary benefits, which provide colleagues with access to group rates on insurance and discounts. Colleagues have access to tuition discounts at Thomas Jefferson University after one year of full time service or two years of part time service. All colleagues, including those who work less than part-time (including per diem  colleagues, adjunct faculty, and Jeff Temps ), have access to medical (including prescription) insurance.

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