Case Management Representative

At Houston Methodist, the Case Management Representative position is responsible for providing clerical assistance and data management support to the case management and social work department to facilitate efficient utilization of resources and discharge planning including referrals management, communication and collaboration with post-acute care providers, access to agencies and other community resources and transportation. This position may perform some secretary duties and performs a wide variety of administrative duties of a higher complexity in support of Case Management operations.

Responsibilities

Provide clerical assistance and data management support to the case management and social work department; Facilitate efficient utilization of resources and discharge planning, including referrals management; Communicate and collaborate with post-acute care providers; Provide access to agencies and other community resources and transportation; Perform some secretary duties and a wide variety of administrative duties of higher complexity; Provide competent and professional assistance to meet the needs of social workers/case managers and patients; Coordinate, oversee, record, and transmit information pertinent to resource management of patients to next level of care providers; Serve as a department resource for case management questions; Perform phone call and communication triage and route issues to appropriate individuals; Distribute Medicare Notices of Discharge and capture required signatures; Coordinate with clinical staff to prioritize placement requests; Provide documentation to facilitate post-acute services; Schedule follow-up appointments and confirm delivery of post-acute services or equipment; Participate in quality improvement initiatives and collect data for department performance improvement; Maintain and update resources, databases, and directories related to post-acute providers and insurance contacts; Inform social workers/case managers of patients' available insurance/managed care benefits; Participate in reimbursement, certification, and authorization activities; Document payor approvals and authorization numbers; Support concurrent insurance denials and appeals process and utilization review transmission

Requirements

High School diploma or equivalent education (e.g., GED, verification of homeschool equivalency, partial or full completion of post-secondary education); Associate degree preferred; Two years of experience in service recovery, insurance verification, working with patient information, patient contact, and/or general health care coordination within a healthcare environment; Previous experience in hospital setting and/or Case Management; Sufficient proficiency in speaking, reading, and writing English; Ability to effectively communicate with patients, physicians, family members and co-workers with a customer service focus; Some knowledge of community resources; Ability to operate within a Microsoft Office environment, including MS Outlook and MS Word/Excel; Knowledge of Medical Terminology; Excellent telephone, oral and written communication skills; Time management and prioritization skills; Ability to learn new skills effectively; Ability to work independently while collaborating with team members and exercise sound judgment; Strong organizational and problem-solving skills

Nice to have

Associate degree; Previous experience in hospital setting and/or Case Management