*This role is remote to Florida residents only*
Join the Cleveland Clinic team, where you will work alongside passionate caregivers and provide patient-first healthcare. Cleveland Clinic is recognized as one of the top hospitals in the nation. At Cleveland Clinic, you will receive endless support and appreciation and build a rewarding career with one of the most respected healthcare organizations in the world.
As a Care Management Coordinator, you will support the organization and team through monitoring compliance with assigned responsibilities as well as completing daily and weekly tasks and coordinating with patient financial services. Your work will help ensure timely discharges to post-acute facilities and discharge coordination. This role will allow you to expand your knowledge of insurance authorizations as well as potentially move into a supervisor opportunity. Come take this opportunity to work for Cleveland Clinic with a dynamic team of like-minded professionals.
This is a regular PRN position, with caregivers working days between 8:00 a.m. -- 4:30 p.m. with weekend requirements.
A caregiver who excels in this role will:
Facilitate efficient Care Management services.
Monitor compliance with assigned responsibilities, complete daily/weekly tasks and coordinate with patient financial services.
Conduct InterQual initial and continued stay reviews, initial and continued stay clinical authorization and 7- and 10-day LOS clinical and financial justifications.
Ensure coverage for 24/7 on-call process and weekend coverage.
Conduct daily analysis of reports on observation status reviews, daily comparison of anticipated discharges to actual discharges by IM team and attending physician and weekly analysis of assigned tasks of each case manager to ensure completion of Allscripts/ECIN documentation necessary for clinical LOC justification and payer reimbursement.
Distribute results of reports on the efficiency and completion of Care Management activities with staff for staff input, follow-up and feedback.
Ensure InterQual and Allscripts/ECIN reports are distributed to each staff member for action to address identified issues.
Provide daily/weekly reports to the Director of Clinical Process and Risk Management regarding actions taken to assure full compliance with staff performance expectations.
Coordinate authorizations, initial and concurrent clinical reviews, submission of data to payers and status of Kepro data entry with all assigned case managers.
Ensure that both Care Management and Patient Financial Staff have documented authorizations in both Allscripts/ECIN and Invision to ensure Hospital payment for care provided.
Ensure unit/department is staffed to provide adequate coverage appropriate to meet service needs.
Maintain departmental files to assure competency with all assigned tasks and compliance with applicable regulations and standards.
Ensure compliance with CMS/Medicare regulations.
Conduct daily assessments of patient caseloads and assign/reassign staff as needed to ensure patient needs are met.
Provide staff training as needed on the access and use of all IT programs including Invision, Allscripts/ECIN, Epic and KEPRO.
Maintain departmental files to ensure competency with all assigned tasks and compliance with applicable regulations and standards.
Maintain confidentiality and ensure compliance with CMS/Medicare regulations.
Document, circulate and maintain minutes of staff meetings.
Complete bi-weekly payroll and payroll variance reports as required.
Minimum qualifications for the ideal future caregiver include:
Knowledge of financial and utilization review software, including ECIN, InterQual and Kepro
Two years of hospital care management experience
Physical Requirements:
Requires frequent walking from department to department: require sitting at a work-station or desk.
Requires standing.
Work may include occasional publishing and/or pulling, lifting and carrying objects weighing up to 20 pounds such as files, documents and computer printouts.
Work requires finger dexterity and eye/hand coordination to operate a computer keyboard at a moderate skill level.
Personal Protective Equipment:
Follows standard precautions using personal protective equipment as required.
The policy of Cleveland Clinic Health System and its system hospitals (Cleveland Clinic Health System) is to provide equal opportunity to all of our caregivers and applicants for employment in our drug free environment. All offers of employment are followed by testing for controlled substances.
Cleveland Clinic Health System administers an influenza prevention program. You will be required to comply with this program, which will include obtaining an influenza vaccination on an annual basis or obtaining an approved exemption.
Decisions concerning employment, transfers and promotions are made upon the basis of the best qualified candidate without regard to color, race, religion, national origin, age, sex, sexual orientation, marital status, ancestry, status as a disabled or Vietnam era veteran or any other characteristic protected by law. Information provided on this application may be shared with any Cleveland Clinic Health System facility.
If applying for a Florida position, please see the following website for more information on the background screening requirements required by the Agency of Health Care Administration: https://info.flclearinghouse.com/
Please review the Equal Employment Opportunity poster.
Cleveland Clinic is pleased to be an equal employment opportunity employer.
ccf