Participate and assist in daily case management operations, including: assist with utilization management workflow and payer contacts; assist with coordination of all referral types, products, and equipment; facilitating and engaging in bi-directional communication with health care professionals ensuring the accurate and timely dissemination of referral information to facilitate a smooth patient transition to the next level of care; computer data entry in multiple systems; participation in quality assurance, and regulatory compliance activities as needed; and demonstration of competence for working with all patient age groups. Schedule will be 9:30 AM-6:00 PM. Required to participate in weekend and holiday rotation(s).
Accurately and comprehensively disseminate all necessary referral information to vendors in order to facilitate the transition to the next level of care for the patient.
Communicate effectively with all stakeholders inclusive of Care Management staff, insurance carriers and/or their designated intermediaries, and vendors to ensure that transition information is current, accurate, and complete.
Provide concise, applicable, and timely responses to requests for information from vendor/insurance providers using a systematic, efficient, and thorough procedure for retrieving information.
Create and maintain accurate communication in electronic medical record and other applicable software programs as specified by UMHS Care Management Department policy and procedure.
Contribute to the achievement of UMHS Care Management Department goals through effective participation in work groups.
Maximize work efficiency through the use of computers and other technologies as evidenced by proficient skill in accessing and disseminating referral and patient care information.
Maintain confidentiality of patient and proprietary information by observing legal and ethical guidelines for safeguarding the confidentiality of patient and proprietary information.
Provide callers with assistance and redirect calls as needed to appropriate personnel.
Appropriately distribute any correspondence received via FAX, email, phone calls, mail or voicemail as required.
Confirm admissions to post-acute care with vendors and provide appropriate documentation.
Initiate EMR documentation for Care Management staff co-signature after verification of discharge disposition.
Initiate and follow through on appropriate referrals and document in EMR for co-signature by Care Management staff.
Communicate with patients/caregivers when initiating referrals and follow department referral guidelines.
Upon direction from Care Management staff assist with obtaining insurance authorization.
Facilitate timely submission of documentation for appeals.
Schedule and confirm transportation as directed by Care Management staff.
Assists in obtaining and documenting insurance authorizations and approval days in multiple computer programs.
Maintain updated/accurate contact information for vendor/insurance provider in appropriate data base.
Print and deliver packets to units for facility discharges.
Maintain CMS compliance with notice deliveries and consents.
Other Related Duties:
Complies with all University of Michigan Health System and departmental standards and expectations.
Supports the department’s commitment to continuous improvement activities and principles through positive and respectful contribution in all problem-solving and change processes.
Performs other duties as assigned.
High school diploma or general education equivalency
3-4 years experience
Familiarity with obtaining medical records or professional medical billing
Financial counseling experience for healthcare patients
Excellent interpersonal skills and ability to work well within a team setting
Demonstrates active listening, written, verbal and information technology skills
Knowledge of basic medical terminology
Analytical skills are necessary in order to assess urgency and complexity of request so prioritization of workflow can be achieved effectively
An Associate degree in social sciences or other health related field or an equivalent combination of education and experience is necessary.
Experience in the health care environment with a demonstrated knowledge of regulations, standards, and guidelines applicable to home care services.
Proficiency in medical terminology.
Proficiency in use of computer technology and experience with Microsoft Office software applications.
OCCUPATIONAL HAZARD INFORMATION:
The work inherent to this position resides in the health care and office environment settings; exposure to office supplies and equipment is ordinary; exposure to the general health care population is possible.
This job description is intended to indicate the kinds of tasks and levels of work and/or difficulty that will be required of positions given this title and shall not be construed as declaring what the specific duties and responsibility of any particular position shall be. It is not intended to limit or in any way modify the right of any supervisor to assign, direct and control the work of employees under their supervision.
The following signature indicates receipt and understanding of the above job description. A signed copy of this description is kept in the employee file.
Michigan Medicine conducts background screening and pre-employment drug testing on job candidates upon acceptance of a contingent job offer and may use a third party administrator to conduct background screenings. Background screenings are performed in compliance with the Fair Credit Report Act. Pre-employment drug testing applies to all selected candidates, including new or additional faculty and staff appointments, as well as transfers from other U-M campuses.
Michigan Medicine improves the health of patients, populations and communities through excellence in education, patient care, community service, research and technology development, and through leadership activities in Michigan, nationally and internationally. Our mission is guided by our Strategic Principles and has three critical components; patient care, education and research that together enhance our contribution to society.
Job openings are posted for a minimum of seven calendar days. The review and selection process may begin as early as the eighth day after posting. This opening may be removed from posting boards and filled anytime after the minimum posting period has ended.
The University of Michigan is an equal opportunity/affirmative action employer.
Internal Number: 201109
About University of Michigan - Ann Arbor
A great university is made so by its faculty and staff, and Michigan is recognized as one of the best universities to work for in the country. The Michigan culture is known for engaging faculty and staff in all facets of the university to create a workplace that is vibrant and stimulating.For two consecutive years, the Chronicle of Higher Education has placed U-M in its "Great Colleges to Work For" survey. In particular, the university earns high marks for strong relations between faculty and administrators, a collaborative system of governance, strong pay and benefits, and a healthy work/life balance.