Posted:
9/27/2024, 5:12:42 AM
Location(s):
Ohio, United States ⋅ Cleveland, Ohio, United States
Experience Level(s):
Junior ⋅ Mid Level ⋅ Senior
Field(s):
Medical, Clinical & Veterinary
Care Management Coordinator
Cleveland Clinic Martin North Hospital is a fully integrated medical campus that includes diagnostic centers, outpatient surgery and a 24-hour emergency department located in the state-of-the-art hospital. Cleveland Clinic Martin North Hospital is part of the world-renowned Cleveland Clinic, a nonprofit, multispecialty, academic medical center that integrates clinical and hospital care with research and education.
As a Care Management Coordinator, you will support the organization and team through securing authorizations, securing approved bed days and organizing the department’s schedule and daily assignments.
A caregiver in this position works 8:30AM – 5:00PM.
A caregiver who excels in this role will:
Recommend resource utilization.
Facilitate efficient Care Management services.
Monitor compliance with assigned responsibilities, complete daily/weekly tasks and coordinate with patient financial services.
Conduct InterQual initial and continued stay reviews, initial and continued stay clinical authorization and 7- and 10-day LOS clinical and financial justifications.
Ensure coverage for 24/7 on-call process and weekend coverage.
Conduct daily analysis of reports on observation status reviews, daily comparison of anticipated discharges to actual discharges by IM team and attending physician and weekly analysis of assigned tasks of each case manager to ensure completion of Allscripts/ECIN documentation necessary for clinical LOC justification and payer reimbursement.
Distribute results of reports on the efficiency and completion of Care Management activities with staff for staff input, follow-up and feedback.
Ensure InterQual and Allscripts/ECIN reports are distributed to each staff member for action to address identified issues.
Provide daily/weekly reports to the Director of Clinical Process and Risk Management regarding actions taken to assure full compliance with staff performance expectations.
Coordinate authorizations, initial and concurrent clinical reviews, submission of data to payers and status of Kepro data entry with all assigned case managers.
Ensure that both Care Management and Patient Financial Staff have documented authorizations in both Allscripts/ECIN and Invision to ensure Hospital payment for care provided.
Ensures unit/department is staffed to provide adequate coverage appropriate to meet service needs.
Maintain departmental files to assure competency with all assigned tasks and compliance with applicable regulations and standards.
Ensure compliance with CMS/Medicare regulations.
Provide staff training as needed on the access and use of all IT programs including Invision, Allscripts/ECIN, Epic and KEPRO.
Maintain confidentiality and ensure compliance with CMS/Medicare regulations.
Documents, circulates and maintains minutes of staff meetings.
Completes bi-weekly payroll and payroll variance reports as required.
Minimum qualifications for the ideal future caregiver include:
Knowledge of financial and utilization review software, including ECIN, InterQual and Kepro.
Two years of hospital care management experience.
Preferred qualifications for the ideal future caregiver include:
Knowledge of Microsoft Word, Excel and PowerPoint.
Experience with authorizations and working with insurance companies to secure authorizations.
Our caregivers continue to create the best outcomes for our patients across each of our facilities. Click the link and see how we’re dedicated to providing what matters most to you: https://jobs.clevelandclinic.org/benefits-2/
Physical Requirements:
Requires frequent walking from department to department: require sitting at a work-station or desk.
Requires standing.
Work may include occasional publishing and/or pulling, lifting and carrying objects weighing up to 20 pounds such as files, documents and computer printouts.
Work requires finger dexterity and eye/hand coordination to operate a computer keyboard at a moderate skill level.
Personal Protective Equipment:
Follows standard precautions using personal protective equipment as required.
The policy of Cleveland Clinic Health System and its system hospitals (Cleveland Clinic Health System) is to provide equal opportunity to all of our caregivers and applicants for employment in our tobacco free and drug free environment. All offers of employment are followed by testing for controlled substance and nicotine. All offers of employment are follwed by testing for controlled substances and nicotine. All new caregivers must clear a nicotine test within their 90-day new hire period. Candidates for employment who are impacted by Cleveland Clinic Health System's Smoking Policy will be permitted to reapply for open positions after one year.
Cleveland Clinic Health System administers an influenza prevention program. You will be required to comply with this program, which will include obtaining an influenza vaccination on an annual basis or obtaining an approved exemption.
Decisions concerning employment, transfers and promotions are made upon the basis of the best qualified candidate without regard to color, race, religion, national origin, age, sex, sexual orientation, marital status, ancestry, status as a disabled or Vietnam era veteran or any other characteristic protected by law. Information provided on this application may be shared with any Cleveland Clinic Health System facility.
Please review the Equal Employment Opportunity poster.
Cleveland Clinic Health System is pleased to be an equal employment employer: Women / Minorities / Veterans / Individuals with Disabilities
Website: https://clevelandclinic.org/
Headquarter Location: Cleveland, Ohio, United States
Employee Count: 1001-5000
Year Founded: 1921
IPO Status: Private
Last Funding Type: Grant
Industries: Health Care ⋅ Hospital ⋅ Medical ⋅ Non Profit