Case Management Assistant

Wentworth-Douglass Hospital, an affiliate of Mass General Brigham, is committed to supporting patient care, research, teaching, and service to the community. We place great value on being a diverse, equitable and inclusive organization as we aim to reflect the diversity of the patients we serve. At Mass General Brigham, we believe in equal access to quality care, employment and advancement opportunities encompassing the full spectrum of human diversity: race, gender, sexual orientation, ability, religion, ethnicity, national origin and all the other forms of human presence and expression that make us better able to provide innovative and cutting-edge healthcare and research.

The Care Coordination Specialist will be responsible for a designated case load and work with patients and the discharge planners to help facilitate care transitions. Demonstrates competence in the performance of duties and responsibilities related to the support of the implementation of appropriate patient transitions. Manage coordination of patient data in request software. Uses available resources to communicate with members of the interdisciplinary care team. Demonstrates excellence in skills and professional performance.
1. Demonstrates competence in the performance of duties and responsibilities related to supporting the Discharge Planning Case Managers with the implementation of appropriate patient transitions.
a. Provides requested information in both verbal and written forms in order to assist Discharge planners in appropriate assessment, planning and implementation and evaluation of the patient's continuing care needs.
b. Acts as point of contact for and/or direction to appropriate staff members for home health, durable medical equipment, ambulance, housing, skilled nursing facilities, insurance companies and others in order to assure appropriate continuing care services are in place for patient transitions.
c. Assist discharge planners with prior authorizations as needed.
d. Assist discharge planners with VNA referrals and choice form
e. Meet directly with patient/family to obtain the Medicare Important Message, patient signatures and documents per policy and department process.

2. Manage coordination of patient data in Referral request system
. Upload referrals for SNF, ARF, Home Services, Home IC, Enteral therapy and DME after patient/family have been provided with their agency options.
a. Track/manage Referrals on a daily basis to include responding to queries from applicable agencies when applicable.
b. Document all discharge planning activity in Midas per department standards.
c. Books and closes all cases in referral Software per department standards.

3. Demonstrates excellence in skills and professional performance
. Maintains close communication with manager/supervisor on quality of care or risk issues
a. Participates in educational programs as requested/as appropriate
b. Completes special projects as requested by manager/supervisor
c. Prioritizes delegated tasks based on patient and department needs
d. Communicates with patients/families in a manner that is consistent with the WDH service expectations.

4. Coordinates clerical tasks necessary to facilitate the smooth operation of the Case Management Department.
. Directs phone inquiries to appropriate staff members. Takes messages and relays/documents information according to department standards.
a. Maintains work area in a professional, organized and HIPAA compliant manner.
b. Files, faxes, collates and photocopies material as required.
c. Provide internal and external customer services per WDH standards
d. Communicates and collaborates with the interdisciplinary care team regarding needs for the patient.
e. Schedule meetings/book conference rooms as requested.
f. Prepare agendas for both Utilization Review/Discharge Planning monthly meetings and distribute one week prior.
g. Record, compose and distribute meetings minutes in a timely manner.
h. Prepares documents for certified mail and files according to department process.

5. Supports the Utilization Review Case Managers to assist in insurance related transactions to ensure smooth billing processes.
. Communicates with payers and documents detailed instructions on billing, authorization and utilization of service in Midas Certification Entry.
a. Communicates and collaborates with care coordination administrative team and the Financial Clearance Department for insurance purposes.
b. Sends payer requested clinical information to insurance company via fax and documents all authorization data into Midas Certification Entry according to department process.
c. Assist with QIO appeals as needed.

Experience Minimum Required
o Administrative experience supporting a leader and/or a department. Experience preparing reports, memos and documents. Proficiency with MS Office Suite. 5-7 years working in a healthcare clerical hospital precertification, revenue management or Case Management department. The ability to multitask and communicate effectively.
o Data analysis including database design and management
Experience Preferred/Desired
o Administrative experience in a health care setting and assisting with patient care transitions.
Education Minimum Required
o High School diploma. LNA or MA training.
Education Preferred/Desired
o BS in related field
Training Minimum Required
o Proficiency in MS Office suite. Strong written and verbal communication skills.
Training Preferred/Desired
o Medical terminology and/or customer service experience.
Special Skills Minimum Required
o 1. Strong written and verbal communication skills. 2. Ability to communicate effectively with staff, insurance providers and community agencies. 3. Strong organizational and time management skills. 4. Ability to work independently, set priorities and handle multiple responsibilities. 5. Knowledge of principles related to the release of information and maintaining confidentiality of data. 6. Detail oriented. 7. Strong data management and PC skills 8. Understanding of post-acute venues of care community resources. 9. Knowledge of payor authorization/denial process. Experience with electronic medical record. Advanced medical terminology.

WDH Main Hospital

789 Central Ave

Dover 03820