PURPOSE: The purpose of this position is to assist the carrier in coordination of worker’s compensation patients home care needs once home health care is established until the case is closed by the carrier and/or discharged by the physician.
Responsible for the completion on any portion of referral intake process that the Intake Coordinator was unable to complete, if any
Facilitate flow of evaluation(s), orders, and progress notes from provider(s) to Nurse Case Manager or adjuster per MSC nursing department protocol
Review MD orders, initial assessments/evaluations and progress notes on patient, and communicate with provider and carrier per MSC Nursing department procedure to provide updates and ensure progress of patient
Locate provider(s) or contact established provider(s) to arrange additional service for current patient
Communicate with Nurse Case Manager/adjuster and/or provider to ensure appropriate physician orders are obtained and followed
Contact Nurse Case Manager or Adjuster to obtain authorization for additional or continued service(s)
Create purchase order(s) per MSC Nursing department procedure to authorize additional or continuation of service(s) to provider
Utilize appropriate tracking tools, i.e. authorization logs, Outlook Calendar or Task function, to ensure follow-up on critical timelines as outlined in MSC Nursing department procedures for obtaining evaluations/notes, tracking authorizations, and contacting carriers
Coordinate quality assurance issues or concerns involving patient care, retrieval of evaluations and/or notes, and authorization of services closely with assigned Quality Assurance nurse
Maintain thorough, up-to-date documentation on each patient in patient database
Close file per MSC nursing department procedure once Nurse Case Manager or adjuster cease authorization or physician discharges from home care
Rotation for Nursing Department on-call schedule per MSC Nursing Department procedure
Intake referrals for home care, supplies or additional services offered by MSC, data entry referral into patient database, and follow-through on intake process per MSC nursing department procedure
Notify appropriate MSC department(s) of referrals requiring their expertise
Assist in training new associates as requested by Nursing Department Training Leader
KNOWLEDGE, SKILLS, and ABILITIES and OTHER CHARACTERISTICS:
LPN, or MA with a minimum of 2 years experience in acute setting, home care, or front and back medical office
Knowledge of Microsoft Word, Excel, and Outlook
Ability to learn the company’s patient database and adapt to any system changes
Ability to communicate and express ideas; both written and verbal
Ability to organize work flow in a dynamic, fast-paced work environment
Ability to maintain a courteous and professional demeanor in all customer interactions
Ability to follow instructions and meet strict deadlines
Ability to work in a team environment
Ability to read and interpret MD orders and all discipline notes
Ability to adhere to company policy and procedures, HIPAA and state legislation regarding workers’ compensation and home health care
The Associate communicates effectively, both verbally and in writing, with individuals inside and outside the Company.
The Associate works effectively and relates well with others.
The Associate exhibits a professional manner in dealing with others and works to maintain constructive working relationships.
Self-motivated; career-oriented; organized; able to handle stressful situations and take constructive criticism; and not afraid to learn or take on new responsibilities.
MSC Care Management - 17 months ago