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Care Management Coordinator

Company: Cleveland Clinic
Location: Fort Lauderdale
Posted on: May 6, 2021

Job Description:

*Job ID:* 117576.*Responsibilities:* + Facilitate efficient Care Management services. + Monitors compliance with assigned responsibilities, completes daily/weekly tasks and coordinates with patient financial services. + Conducts InterQual initial and continued stay reviews, initial and continued stay clinical authorizations, 7 and 10 day LOS clinical and financial justifications. + Ensures coverage for 24/7 on-call process and weekend coverage. + Gathers data on an ongoing basis for measurement and evaluation of services provided. + Conducts 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. + Distributes results of reports on the efficiency and completion of Care Management activities with staff for staff input, follow-up and feedback. + Ensures InterQual and Allscripts/ECIN reports are distributed to each staff member for action to address identified issues. + Monitors and reports to the Director of Clinical Process daily status of completion of all assigned Care Management responsibilities. + Provides daily/weekly reports to the Director of Clinical Process and Risk Management regarding actions taken to assure full compliance with staff performance expectations. + Identifies and communicates resources needed for department including daily staffing coverage, access to software and hardware systems, materials and supplies. + Coordinates authorizations, initial and concurrent clinical reviews, submission of data to payers and status of Kepro data entry with all assigned case managers. + Ensures that both Care Management and Patient Financial Staff have documented authorizations in both Allscripts/ECIN and Invision to ensure Hospital payment for care provided. + Communicates daily with on-site reviewers and local HMOs to assure full compliance with contractual obligations for payment. + Reviews daily submission of clinical information to payer by each staff. + Ensures unit/department is staffed to provide adequate coverage appropriate to meet service needs. + Maintains departmental files to assure competency with all assigned tasks and compliance with applicable regulations and standards. + Ensures policies and procedures are current and readily available to department staff. + Ensures compliance with CMS/Medicare regulations. + Conducts daily assessments of patient caseloads and assigns/reassigns staff as needed to ensure patient needs are met. + Utilizes on-call and per diem staff within budget constraints to assure appropriate staffing levels. + Explains work assignments, methods, procedures and policies in such a manner that employees understand expectations. + Provides staff training as needed on the access and use of all IT programs including Invision, Allscripts/ECIN, Epic and KEPRO. Ensures that all personnel attend required annual educational sessions. + Maintains departmental files to ensure competency with all assigned tasks and compliance with applicable regulations and standards. + Ensures policies and procedures are current and readily available to department staff. + Disseminates revised policies to all staff as needed. + Maintains confidentiality and ensures compliance with CMS/Medicare regulations, including: a. Patient choice for aftercare services b. Daily documentation of receipt of the Important Message c. Notices of non coverage as required by regulations. + Ensures that written and verbal communication that is two-way is timely and appropriate. + Coordinates regularly scheduled staff meetings; not less than 4 per year. + Documents, circulates and maintains minutes of staff meetings. Provides appropriate and timely information to staff. + Coordinates services effectively with other department directors, supervisors, coordinators and Administration. + Complies with all policies and procedures including attendance. + Ensures supplies are available and charged or expensed appropriately. + Ensures equipment and the physical unit/department are maintained properly. + Revises daily/weekly staffing according to unit/department needs. + Promotes cost effective unit/department operations. + Completes bi-weekly payroll and payroll variance reports as required. + Performs job tasks in accordance with hospital and department policies and procedures including appropriate use of equipment, machines, wearing of physical barriers and safety equipment. + Other duties as assigned..*Education:* + Knowledge of financial and utilization review software, including ECIN, InterQual and Kepro..*Languages:* + N/A.*Certifications:* + N/A.*Complexity of Work:* + All employees are expected to meet the standards of performance outlined in the Organizational-Wide Competencies listed below as applied to the position: + World Class Service Orientation: Includes attitude, behavior, interpersonal skill, and problem solving that enable an employee to respond to internal and external customer needs and expectations in a positive manner. + Adaptability: Includes teamwork and flexibility needed to fulfill job responsibilities including adapting to changes in work environment and accepting supervisory feedback. + Efficiency and Effectiveness: Includes quantity and quality of desired work, as well as organization skills necessary to perform successfully. + Essential Job Requirements: Includes adherence to all relevant policies, procedures, and guidelines affecting the work environment, including maintenance of required competencies and communication skills. + Supervisory Responsibilities (if applicable): Includes overall accountability for assigned work group relative to operational goals, personnel requirements, and budgetary constraints. + Note: The above stated duties are intended to outline those functions typically performed by individuals assigned to this classification. This description of duties is not intended to be all inclusive nor to limit the discretionary authority of supervisors to assign other tasks of similar nature or level of responsibility. + Effective verbal, written and computer skills..*Work Experience:* + 2 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. Cleveland Clinic is pleased to be an equal employment/affirmative action employer: Women/Minorities/Veterans/Individuals with Disabilities.

Keywords: Cleveland Clinic, Fort Lauderdale , Care Management Coordinator, Executive , Fort Lauderdale, Florida

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