Case Management Associate
Spaulding Hospital-Boston & Cambridge(SRN,SRH,SHC)

Summary:

Reporting to the Manager of Case Management and working under the direction of the Case Managers (CM) and Social Work (SW) staffs, the Case Management Associate provides support to Case Managers and Clinical Social Workers with routine and regulatory clinical and administrative functions.
Key Responsibilities:

• Provides administrative support related to the discharge process through faxing, copying, and scanning of information, including but not limited to referral sources, insurers, PCP offices; booking rooms for family-team meetings; assisting patients with securing new PCP's prior to discharge; researching DME providers.

• Supports the process of patient referral to SNF, home care, and outpatient. The referral process includes entering clinical information into the 4NEXT referral system and managing the communications regarding acceptance and bed offer or denial with facilities; referrals to outpatient via SharePoint; and contacting home care agencies via telephone with pre-referral information and to establish a start of care date; initiating the patient care referral paperwork.

• Supports the insurance authorization and continued stay process by making initial contact with the insurance CM to confirm contact information and to establish contacts between the payer and SRH CM; submitting fax and online requests for continued stay authorization and monitors the decision from the payer.

• Researches available community resources at the request of the CM or SW.

• Assists the CM, SW, patient and/or family with applications for community resources, such as PT1, handicap placards, and specialized funds.

• Maintains a database for insurance-based processes, e.g. denials and appeals, Medicaid conversion requests and decisions.

• Contacts patients after discharge to home to complete the "Post Discharge Follow-up Phone Call" process and documents the calls per department protocol.

Qualifications
Qualifications and Experience

Education/Degree

Preferred

• Bachelor's of Social Work from an accredited institution preferred. However, would substitute experience and complimentary of Associate Degree

Experience

Required

• A minimum of 1-2 years of clinical and/or community resource experience required

Skills (Specific learned activity gained through training (e.g. computer skills, keyboarding, presentation, CPR, ACLS, etc.)

• Computer proficiency required. Microsoft office applications preferred with ability to learn new software.

• Highly developed communications and interpersonal skills, working with diverse population.

• Work independently, be self-directed and contribute as a member of a team.

• Anticipates challenges and develops and implements strategies for addressing them.

• High level of service delivery. Demonstrate initiative with ability to prioritize work, meet deadlines and adapt to changing situations.

• Attention to detail.

EEO Statement
SRN is committed to diversity in the workplace which begins with respect and opportunity for all. SRN takes affirmative action to ensure that equal employment opportunity is provided to all persons regardless of race, religious creed, color, national origin, sex, sexual orientation, gender identity, genetic information, age, ancestry, veteran status, disability or any other basis that would be inconsistent with any applicable ordinance or law. If you need a reasonable accommodation in coming to or participating in the interview process, please let us know.