Supervisor, Integrated Case Management Specialist - Full-Time

Location

Hackensack, NJ | United States

Job description

Our team members are the heart of what makes us better. At Hackensack Meridian Health we help our patients live better, healthier lives — and we help one another to succeed. With a culture rooted in connection and collaboration, our employees are team members. Here, competitive benefits are just the beginning. It’s also about how we support one another and how we show up for our community. Together, we keep getting better - advancing our mission to transform healthcare and serve as a leader of positive change.

The Integrated Case Management Specialist, Supervisor performs selected services and functions related to the supervision and oversight of the integrated case management specialist team, both
respective to Care Coordination and Utilization Review. General responsibilities are including but not limited to; data collection and monitoring, pre-operative arrangements, and preparing required appeals and denial information for processing, including the Livanta appeal management process and the IM letter from Medicare.

A day in the life of a Supervisor, Integrated Case Management Specialist at Hackensack Meridian Health includes:

General Responsibilites:

• Scheduling of Integrated Case Management Specialist team members.
• Payroll approval for Integrated Case Management Specialist team members.
• PTO approval/denial/review for Integrated Case Management Specialist team members.
• Ensuring phones are answered in a timely manner.
• Ensuring voicemails are checked, followed up on, and distributed in a timely manner.
• Planning and coordinating monthly Integrated Case Management Specialist team meetings and huddles regularly.
• In collaboration with management, assist with HR and related team member issues pertaining to the specialist team.
• Performs office support services to facilitate efficient running of the department, i.e., phone call management, messages, mail/correspondence and other clerical support duties as delegated by the Manager.
• Provides support and coverage of front-end administrative responsibilities as requested.
• Participates in quality improvement efforts for the department to assist in improving work efficiency, and to help meet the goals of the department, files the required documents.
• Other duties and/or projects as assigned.
• Contribute to the onboarding, orientation and training of new team members.
• Adheres to HMH Organizational competencies and standards of behavior.

Care Coordination Responsibilities:

• Pre-operative patient phone calls and arrangements for the following: Orthopedics, breast surgery and cardiac surgery.
• Monitoring the workflow of all Care Coordination specialists in respect to: Obtaining post-acute authorizations, IM letter distribution, call rotations, timely response to Care Coordination inquiries, etc.
• Knowledge of process and possesses the ability to obtain post-acute authorizations as needed.
• Establishing a workflow and work division for IM letter distribution by Care Coordination Specialists to inpatients prior to discharge, according to CMS guidelines.
• Monitoring and reviewing performance and productivity of Care Coordination specialists regularly.
• Oversight and monitoring of the Livanta discharge appeal process carried out by the Care Coordination Specialists.
• All other responsibilities as assigned/needed.

Utilization Review Responsibilities:

• Assign logs to Utilization Review Specialists based on department needs/volume.
• Oversee throughput for the denial process.
• Review insurance logs daily for urgent requests.
• Review log for denials, flag Utilization Review RN in Xsolis.
• Send logs via email daily to Utilization Review RNs.
• Clinical requests via telephone flag Utilization Review RN in Xsolis.
• Send logs back to payers with SIH, discharge date and disposition.
• All other responsibilities as assigned/needed

Education, Knowledge, Skills and Abilities Required:

• High School diploma, general equivalency diploma (GED), and/or GED equivalent programs.
• Minimum of three or more years of relevant healthcare experience.
• Experience with insurance, denials/appeals, pre-authorizations.
• Excellent written and verbal communication skills.
• Proficient computer skills that include but are not limited to Microsoft Office and/or Google Suite platforms.

Education, Knowledge, Skills and Abilities Preferred:

• Associate's Degree or higher.
• Five years recent experience in a hospital or medical setting.
• At least 3 years working in a relevant case management role/capacity.
• Bi-lingual, Spanish-speaking preferred.

Contacts:

• Regular contact with Medical Center personnel, patients, visitors, community agencies, and insurers.

Working Conditions:

• Lifts 1-5 lbs., pushes and pulls a minimum of 5 lbs. and stands a minimum of 1 hour a day.

If you feel the above description speaks directly to your strengths and capabilities, then please apply today!

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