SLH Care Management Specialist - Alameda Health System
Company: Alameda Health System
Location: San Leandro
Posted on: April 26, 2024
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Job Description:
Summary SUMMARY: Assists in Care Management Team of social
workers and nurses with functions such as but not limited to
provide census reconciliation, administrative support for care
coordination and discharge planning activities, working with the
payors, accurate and critical information data entry and tracking,
and report creation. DUTIES & ESSENTIAL JOB FUNCTIONS: NOTE: The
following are the duties performed by employees in this
classification. However, employees may perform other related duties
at an equivalent level. Not all duties listed are necessarily
performed by each individual in the classification. 1. Functions as
a key point of contact between clinical case management staff,
admissions and payors. Documents all interactions with payors and
communicates status with Care Management staff. 2. Coordinates and
obtains authorizations for admissions; documents all information in
the AHS financial system; works closely with Revenue Cycle to
ensure each inpatient encounter is accurate; coordinates all
reviews and inquires with the payors. 3. Reconciles census; works
with Patient Access and the Care management team to ensure census
is correct in the financial and care management systems; prepares
paperwork and updates encounter information for admissions,
discharges and transfers of patients; prepares census for the Care
Management staff. 4. Collaborates with Case Management staff to
provide specific clinical information for the purpose of completing
initial and concurrent utilization review to ensure
certification/approval of in-patient and post discharge services.
5. Per the direction of the Care Management social worker and/or
nurse, facilitates, identifies and documents all referrals made to
contracted facilities, providers or agencies, makes post discharge
appointments for patients and coordinates transportation; expedites
discharges by transmitting appropriate documentation to providers
for acceptance of patient; documents all interactions with payers
and communicates status with appropriate staff. 6. Manages multiple
inquiries and presents referral based on location and services
provided; appropriate follow up on active or pending inquires. 7.
Coordinates with referral sources on bed availability, new product
and services; maintains current database of existing and potential
referral sources. 8. Communicates status with Care Management staff
and arranges for patient transfer; functions as a key point of
contact between Care Management staff, admissions and payers. 9.
Coordinate and track any communication, e.g. Important Message (IM)
letters, Denial Letters, patient choice forms; regularly updates
Care Management team. 10. Supports any audits with coordinating
medical records with HIM; prepares statements of diagnosis and
treatments, and extracts other information required for the
completion of forms received from patients' insurance carriers. 11.
Perform all other duties as assigned. MINIMUM QUALIFICATIONS:
Required Education: High School Diploma or G.E.D. Preferred
Education: Bachelor's degree in related field. Required Experience:
Three years in a health care field or one year in Utilization
Management at a Medical Group or Health plan experience; electronic
Health Record (EHR) and Case Management applications, e.g. Midas or
3M. Preferred Experience: Medical Assistant. San Leandro Hospital
SLH Social Services Services As Needed / Per Diem Day Care
Management FTE: 0.01
Keywords: Alameda Health System, Castro Valley , SLH Care Management Specialist - Alameda Health System, Healthcare , San Leandro, California
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