Disease Management Case Manager jobs in Mobile, AL

Overview

USA Health is Transforming Medicine along the Gulf Coast to care for the unique needs of our community. USA Health is changing how medical care, education and research impact the health of people who live in Mobile and the surrounding area. Our team of doctors, advanced care providers, nurses, therapists and researchers provide the region's most advanced medicine at multiple facilities, campuses, clinics and classrooms. We offer patients convenient access to innovative treatments and advancements that improve the health and overall wellbeing of our community.

Responsibilities

Supports Utilization Management Staff by facilitates timely transmission of clinical information to payors  in coordination with Utilization Management team, communicates pertinent information obtained from/received by payors to appropriate member of Utilization Management team, documenting authorization and/or reference numbers received by payors as specified by department policy, documents receipt of denial and informs appropriate Utilization Management Staff of receipt of denial notification, distributes of MOON letters, Condition Code 44 notifications, Important Message Forms, and Hospital Issued Notices of Non-coverage letters, develops and implements a front-end/concurrent review program for accounts referred due to the potential for revenue cycle corrections, identifies accounts warranting a bill hold and implements bill hold as indicated thru account analysis, releases bill holds when appropriate after thorough account analysis has been performed, adjusts room/bed charges on accounts in which corrections are indicated based on census, performs initial screening for EPSDT referrals and changes insurance and charges account when appropriate, monitors Insurance Task List for primary insurance changes and PSO changes and communicates changes to appropriate Utilization Management Staff timely, and collaborates with Patient Access and Business Office to ensure accuracy of patient and payor information and update information to all appropriate staff in a timely manner as needed; provides support to Discharge Planning Staff by prepares paperwork needed for all discharge planning meetings, assists in the research for available post-acute care and community services available to help facilitate discharge planning, communicates pertinent information to vendors and/or representatives from post-acute service providers as needed, orders DME to be maintained at par level and ensures DME is delivered timely to appropriate discharge planning staff, maintains working knowledge of agency and community resources and updates available resources for department use as needed, monitors open consults task list and communicates pending consults to appropriate discharge planning/social services staff, monitors pending communication in Water Shed and facilitates timely responses by discharge planning/social services staff; provides support to Care Management Leadership Team by functions as receptionist by greeting visitors and answering telephone calls to main office line, arranges and coordinates departmental meetings, schedules interviews, prepares, maintains, and distributes meeting agendas, minutes, and/or other appropriate related materials as needed, orders office supplies to maintain par level, prepares new requisitions for new equipment and supplies and routes requests appropriately, maintains financial information in preparation for department budget, maintains and updates all relevant spreadsheets and manuals related for Care Management Department, assists in data acquisition and management, prepares and reconciles travel documents by completing necessary paperwork, confirming registrations/reservations, and processing reimbursement when applicable, coordinates and schedules education opportunities for Care Management Staff, receives, reviews, and distributes departmental mail appropriately and timely, maintains office filing system, maintains online policy manuals, and provides Notary services;  regular and prompt attendance; ability to work the schedule as defined and overtime and call as required; related duties as required.

Qualifications

High school diploma or equivalent and four years of clerical or secretarial experience. Higher level education from an accredited institution as approved and accepted by the University of South Alabama will substitute on a year-for-year basis for the required experience.