What are the responsibilities and job description for the Case Manager Behavioral Health position at Atrium Health Navicent?
Department
11215 Navicent Non Enterprise Corporate - Utilization Management
Status
Full time
Benefits Eligible
Yes
Hours Per Week
40
Schedule Details/Additional Information
Monday-Friday 8a-5p including afterhours and on-call weekends
Pay Range
$26.55 - $39.85
Major Responsibilities
Coordinates the patient’s care throughout their stay.
Preferred Certification/License/Registration
Our CommitmenttoYou
Advocate Health offers a comprehensive suite of Total Rewards: benefits and well-being programs, competitive compensation, generous retirement offerings, programs that invest in your career development and so much more – so you can live fully at and away from work, including:
Compensation
Advocate Health is the third-largest nonprofit, integrated health system in the United States, created from the combination of Advocate Aurora Health and Atrium Health. Providing care under the names Advocate Health Care in Illinois; Atrium Health in the Carolinas, Georgia and Alabama; and Aurora Health Care in Wisconsin, Advocate Health is a national leader in clinical innovation, health outcomes, consumer experience and value-based care. Headquartered in Charlotte, North Carolina, Advocate Health services nearly 6 million patients and is engaged in hundreds of clinical trials and research studies, with Wake Forest University School of Medicine serving as the academic core of the enterprise. It is nationally recognized for its expertise in cardiology, neurosciences, oncology, pediatrics and rehabilitation, as well as organ transplants, burn treatments and specialized musculoskeletal programs. Advocate Health employs 155,000 teammates across 69 hospitals and over 1,000 care locations, and offers one of the nation’s largest graduate medical education programs with over 2,000 residents and fellows across more than 200 programs. Committed to providing equitable care for all, Advocate Health provides more than $6 billion in annual community benefits.
The Non-clinical Case Manager is responsible for collaborating with other utilization reviewers/case managers, providers, assessors, outpatient/inpatient clinical staff, therapists, revenue cycle staff, and insurance plans to provide a comprehensive presentation of a patient’s plan of care, progress towards goals, and ongoing care needs. The non-clinical case manager advocates for authorization for services in compliance with Centers for Medicare and Medicaid Services (CMS) guidelines and applies applicable utilization review criteria as per the expectation pertaining to specific payers, such as Medicare, Medicaid, and private insurance. The non-clinical Case Manager is also responsible for keeping organized and current documentation on patients and ensures the availability of sufficient clinical and financial information to enable the health care team to function efficiently within the continuum of care and resources.
11215 Navicent Non Enterprise Corporate - Utilization Management
Status
Full time
Benefits Eligible
Yes
Hours Per Week
40
Schedule Details/Additional Information
Monday-Friday 8a-5p including afterhours and on-call weekends
Pay Range
$26.55 - $39.85
Major Responsibilities
Coordinates the patient’s care throughout their stay.
- Collaborates with the health care team in evaluating the appropriate use of resources, such as medications, procedures, protocols, and tests. Ensures progress towards departmental improvement goals relative to length of stay (LOS) and cost per case.
- Identifies need for referral to appropriate discipline. Participates in Care Conferences as requested.
- Maintains an informed status of reimbursement plans, requirements, and guidelines for hospitalization and alternate level of care services.
- Communicates status to the health care team.
- Contacts the attending physician and other health care providers whenever additional information is needed for assessment, care planning, or reimbursement purposes.
- Obtains insurer’s approval for services by providing the insurer with pertinent medical information. Ensures progress towards departmental goals for denial management.
- Collaborates with the health care team (nurse, pharmacist, physician, therapist, Physician) in monitoring appropriateness of test/procedures, medications, consultations, and treatment plans.
- In conjunction with Social Service, handles Hospital Issued Notice of Non-Coverage (HINN). Coordinates insurance approvals and obtains pre-certs for all payer sources.
- Documents insurance information/authorization numbers in relative software applications. Documents calls and related information on designated forms.
- Establishes and maintains positive relationships with patients, physicians, allied professionals, and all peers. Supports facility internal and external customer service standards.
- Participates in training and development activities to enhance own knowledge and skills Reviews all cases to assure admission criteria is met.
- Communicates to the physician if further documentation is needed by regulatory regulations.
- Assistwith chart audits from outside insurance companies. Writesappealsasneededtoinsurance companies.Arrangespeertopeerreviewswith physicians and insurance companies.
- Reports anyknowncompliance issuestoDirector and Assistant DirectorofCoordinated Careand DirectorofBHFinancialOperations/RevenueCycleOperations.
- None
- Bachelor's degree in Business, Education, Counseling, HumanServicesor related field from an accredited institute
- Minimumoftwoyears’experienceinthecareofassignedpatientpopulation Workingknowledgeofcommunityresources
- Expert knowledge of ICD, CPT, and HCPCS coding guidelines.
- Expert knowledge of medical terminology, anatomy, and physiology.
- Expert ability to identify coding quality issues/concerns and provide recommendations for improvement.
- Expert ability to analyze trends and data and display them in a statistical reporting format.
- Expert organization and communication (verbal and written) skills.
- Expert ability to effectively train others through oral and/or written methods.
- Expert organization, prioritization, and reading comprehension skills.
- Expert analytical skills, with high attention to detail.
- Expert knowledge of Microsoft Office, video and web conferencing, email, and experience with electronic coding and EHR systems or applications.
- Expert knowledge of care delivery documentation systems and related medical record documents.
- Expert interpersonal communication skills (oral and written) necessary to collaborate with Physicians, other clinicians, and Professional Coding Department team members and leadership.
- Ability to work independently and exercise independent judgment and decision-making.
- Ability to meet deadlines while working in a fast-paced environment.
- Ability to take initiative and work collaboratively with others.
- Ability to meet deadlines while working in a fast-paced environment.
- Strong sense of ethics.
- Experience with remote workforce operations required.
- Frequent sitting and/or standing, oftenforlongperiodsoftime. Frequentwalkingbending, stooping,pushing,twistingandturning.Occasionally lifts10 poundsormoreofoffice relatedequipmentorsupplies. Eye-hand coordination and manual dexterityinreaching,graspingand handling withrepetitiveuseofhandsandfingersinoperatingcomputer,calculator,telephone,copier,faxandsimilarofficeequipment.Abilitytodistinguish letters,numbersandsymbolswithnormalrangeofvisionandhearingandabilitytocommunicateverballyandinwriting.Work-relatedstressdue tovolumeandtimeconstraints.Mayrequiretravelbyvehicletoalternativelocations.
Preferred Certification/License/Registration
- Case Management and Utilization Review certification encouraged
- Master's Degree in related field
- Working knowledge of community resources
Our CommitmenttoYou
Advocate Health offers a comprehensive suite of Total Rewards: benefits and well-being programs, competitive compensation, generous retirement offerings, programs that invest in your career development and so much more – so you can live fully at and away from work, including:
Compensation
- Base compensation listed within the listed pay range based on factors such as qualifications, skills, relevant experience, and/or training
- Premium pay such as shift, on call, and more based on a teammate's job
- Incentive pay for select positions
- Opportunity for annual increases based on performance
- Paid Time Off programs
- Health and welfare benefits such as medical, dental, vision, life, andShort- and Long-Term Disability
- Flexible Spending Accounts for eligible health care and dependent care expenses
- Family benefits such as adoption assistance and paid parental leave
- Defined contribution retirement plans with employer match and other financial wellness programs
- Educational Assistance Program
Advocate Health is the third-largest nonprofit, integrated health system in the United States, created from the combination of Advocate Aurora Health and Atrium Health. Providing care under the names Advocate Health Care in Illinois; Atrium Health in the Carolinas, Georgia and Alabama; and Aurora Health Care in Wisconsin, Advocate Health is a national leader in clinical innovation, health outcomes, consumer experience and value-based care. Headquartered in Charlotte, North Carolina, Advocate Health services nearly 6 million patients and is engaged in hundreds of clinical trials and research studies, with Wake Forest University School of Medicine serving as the academic core of the enterprise. It is nationally recognized for its expertise in cardiology, neurosciences, oncology, pediatrics and rehabilitation, as well as organ transplants, burn treatments and specialized musculoskeletal programs. Advocate Health employs 155,000 teammates across 69 hospitals and over 1,000 care locations, and offers one of the nation’s largest graduate medical education programs with over 2,000 residents and fellows across more than 200 programs. Committed to providing equitable care for all, Advocate Health provides more than $6 billion in annual community benefits.
The Non-clinical Case Manager is responsible for collaborating with other utilization reviewers/case managers, providers, assessors, outpatient/inpatient clinical staff, therapists, revenue cycle staff, and insurance plans to provide a comprehensive presentation of a patient’s plan of care, progress towards goals, and ongoing care needs. The non-clinical case manager advocates for authorization for services in compliance with Centers for Medicare and Medicaid Services (CMS) guidelines and applies applicable utilization review criteria as per the expectation pertaining to specific payers, such as Medicare, Medicaid, and private insurance. The non-clinical Case Manager is also responsible for keeping organized and current documentation on patients and ensures the availability of sufficient clinical and financial information to enable the health care team to function efficiently within the continuum of care and resources.
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