Job Vacancy Case Management Resource Specialist Massachusetts General Hospital


Job title: Case Management Resource Specialist

Company: Massachusetts General Hospital

Job description: Reporting to a Nurse Manager for the Case Management Department, the Case Management Resource Specialist (CMRS) is an active member of the CM team and works collaboratively with the Acute Case Management RN Case Managers, providing direct administrative support to the discharge planning processes and to the department. The person in this position will spend time on the clinical units and have direct interaction with patients and their families, clinical and ancillary hospital staff, and other internal and external customers.

  • Provides direct support to Case Manager on clinical units
  • Verifies patient demographics including address, telephone number and insurance
  • Initiates High Risk screen as requested by Case Manager
  • Queries patients to past VNA and Pharmacy preferences
  • Verifies presence of a HCP
  • Participates in Discharge Planning rounds as requested by Case Manager to obtain census of potential /actual discharges
  • Initiates VNA referrals and contacts VNA agencies to confirm visit upon discharge
  • Initiates screening process for rehabilitation facilities utilizing the 4Next process
  • Communicates with facility staff to discuss requests for complex patient discharges
  • Reaches out to facilities for screening determinations if no response within 24 hours
  • Researches/queries Insurers for network information (VNA Agencies, Durable Medical Equipment
  • (DME) vendors, Rehabilitation facilities), transportation benefit verification
  • Obtains DME as requested by Case Managers
  • Works collaboratively with Case Manager or Case Manager Specialist to coordinate ground or air ambulance transportation and or repatriation
  • Distributes IM notices for Medicare patients and completes all required IM documentation
  • Distributes MOON notices for Medicare patients and completes all required MOON documentation
  • Ensures Case Manager’s Taxi voucher supply is at the required amount
  • Completes forms as identified by Case Managers (i.e. Pharmacy or Taxi vouchers)
  • Communicates clinical information provided by Case Managers to payers to comply with utilization review requirements
  • Management of centralized ambulance form collection process
  • Management of the RSO communication process
  • Management of Blue Cross authorization and communication process (DINR report)
  • Management of daily faxed communication to/from payers
  • Management of Insurance Change Notification process
  • Management of Insurance line voice mail
  • Data entry of payer contact info
  • Faxing payer logs to appropriate contacts
  • Faxing/copying of patient’s medical record to support discharge referrals as needed.
  • Supports the coordination and faxing of the Medicaid Long Term Care Pre-admission Screening form
  • Provide demographic information to Partners Health Care on OB referrals.
  • Initiates payer requests for retrospective reviews

Qualifications

  • High school diploma, GED required
  • Some college or Bachelor’s degree preferred
  • Minimum of 2 years work experience, preferably in healthcare
  • Knowledge and understanding of medical terminology
  • Excellent computer skills, including proficiency with electronic medical records
  • Strong organizational and prioritizing skills
  • Flexibility and accountability
  • Strong communication, interpersonal and customer service skills
  • Excellent assessment and problem-solving skills

Expected salary:

Location: Boston, MA

Job date: Fri, 08 Jul 2022 07:19:28 GMT

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