Care Management Tech

About This Role

This role supports Care Management functions at DMC Sinai-Grace Hospital by facilitating care coordination activities, managing transition planning, and communicating with third-party payers for patient disposition. The position involves data entry for utilization and denial management, as well as maintaining utilization review files.

Responsibilities

• Provide assistance to Care Management functions for the site
• Participate as a member of the Care Management Team to facilitate process flow in care coordination activities and transition planning
• Communicate with Third Party payers and other community resources to assist in the patient disposition process
• Interface with Patient Financial Services on issues related to eligibility, benefit coverage, and appropriate provider
• Perform input into various databases for utilization management, LOS management and Denial Management activities
• Audit data input and correct errors, as needed
• Investigate and respond to inquiries related to the authorization process, benefit coverage and general concerns
• Maintain necessary utilization review files for all patients in the hospital
• Validate discharge dispositions and assist with issuing Medicare Important Message letters prior to discharge
• Establish and maintain effective relationships with physicians and all other staff members, internally and externally
• Identify problems or any dissatisfaction experienced by any customer or referring source and work to resolve them
• Perform related clerical/secretarial duties as needed

Requirements

• High school diploma or equivalent
• 1-2 years related experience in an outpatient clinic or hospital setting
• 6-12 months of data entry experience
• Interpersonal skills to effectively communicate with third party payers, hospital staff and various other internal/external contacts
• Written and oral communication skills
• Manual dexterity to type and enter data using the computer
• Ability to utilize computer systems

Qualifications

• High school diploma or equivalent.
• 1-2 years related experience in an outpatient clinic or hospital setting, including 6-12 months of data entry experience.

Nice to Have

• 1-2 years work experience in an insurance, medical records, billing or related area
• Medical Assistant certification
• License to practice as a Licensed Practical Nurse (LPN)
• College coursework in heath care
• Additional training in computer applications
• Working knowledge of medical terminology
• Knowledge of managed care and referral processes

Skills

* Required skills

Benefits