Case Management Coordinator Job Description

Case Management Coordinator Job Description

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Case management coordinator provides support to the national and local health authorities to develop and communicate messages with the medical and health communities on clinical features and effective behaviours.

Case Management Coordinator Duties & Responsibilities

To write an effective case management coordinator job description, begin by listing detailed duties, responsibilities and expectations. We have included case management coordinator job description templates that you can modify and use.

Sample responsibilities for this position include:

Maintains a working knowledge of care management, care coordination changes, utilization review changes, authorization changes, contract changes, regulatory requirements, Serves as a educational resource to all AHN staff regarding utilization review practice and governmental commercial payer guidelines
Subject Matter expert on health systems, commercial insurance, Medicare/Medicaid and the Medicaid Screening process
Communicates with courtesy and respect
Patient satisfaction scores meet organization goals
Provides hospital information to members of CM/CDIS
Data entry meets department standard on a daily basis
Computer competence, Excel, Access, Word and Power Point
Data entry competencies
Proven Clerical skills, Typing and filing
Knowledge of concepts and processes regarding managed care authorizations, denials and appeals

Case Management Coordinator Qualifications

Qualifications for a job description may include education, certification, and experience.

Licensing or Certifications for Case Management Coordinator

List any licenses or certifications required by the position: CPR, CM, MA, BLS, AHA, CCBMA, NCCT, AMT, AAMA, CCM

Education for Case Management Coordinator

Typically a job would require a certain level of education.

Employers hiring for the case management coordinator job most commonly would prefer for their future employee to have a relevant degree such as Bachelor's and Associate Degree in Social Work, Education, Nursing, Health, Psychology, Human Services, Counseling, Healthcare, Marriage and Family Therapy, Management

Skills for Case Management Coordinator

Desired skills for case management coordinator include:

Medicare regulations
Chromosomal anomalies and neural tube defects and associated clinical features
Genetics and birth defects
HCG
Health education
Inhibin and future prenatal screening tests
UE3
Care management processes
Medical management policies and procedures
Commercial

Desired experience for case management coordinator includes:

Graduate of an accredited School of Nursing, LPN Nursing
One year of experience in Case Management or in the Managed Care arena, LPN, and or Associates Degree and/or working knowledge of hospital revenue cycle and coding, medical billing
Current license as a Licensed Practical Nurse in Florida
CPUR, CPHM (Preferred)
Coordinates regularly scheduled staff meetings
Documents, circulates and maintains minutes of staff meetings

Case Management Coordinator Examples

1

Case Management Coordinator Job Description

Job Description Example
Our company is growing rapidly and is hiring for a case management coordinator. Please review the list of responsibilities and qualifications. While this is our ideal list, we will consider candidates that do not necessarily have all of the qualifications, but have sufficient experience and talent.
Responsibilities for case management coordinator
  • Coordinating and maintaining all office management functions
  • Independently managing patient discharge function, such as transportation and nursing home returns
  • Intervening with insurance companies on utilization review activity
  • Contacts members that are new to the IPA either by phone or mail, introducing the care coordination team and process
  • May initiate the initial assessment for low risk members and coordinates post discharge appointments with PCP’s and specialist
  • Assist Case Managers with planning for discharge by generating authorizations and scheduling appointments for services needed within 3-5 business days of discharge
  • Retrieves medical records, HRA, Trigger reports Claims documents from Health Plan, providers, Attaches documents to cases in Essette
  • Collaborates with the hospital and SNF staff to obtain daily census, discharge summaries, medication reconciliation information
  • Monitors delivery of care across all markets
  • Maintains daily admissions and discharge records
Qualifications for case management coordinator
  • 6 months of RN Case Management experience preferred
  • Expedites and coordinates appointments for assigned hospitalized patients
  • Keeps all providers involved with member's care updated on appointments, condition, and additional clinical support needed
  • Requests and gathers necessary medical
  • Maintains accurate and complete documentation in Case Management database
  • 2 years of experience in Case Management Care Coordination in an HMO environment
2

Case Management Coordinator Job Description

Job Description Example
Our growing company is searching for experienced candidates for the position of case management coordinator. Please review the list of responsibilities and qualifications. While this is our ideal list, we will consider candidates that do not necessarily have all of the qualifications, but have sufficient experience and talent.
Responsibilities for case management coordinator
  • Implements a discharge plan as necessary
  • Performs Clinical Care Coordination assessment within 72 hours of admission on all patients
  • Offer services to members and their families who have acute and complex health care needs
  • Analyzes and monitors compliance with accrediting and regulatory agency standards, including TJC, CMS, QIO, licensing boards
  • Clinical Documentation experience (preferred)
  • BSN graduate from an accredited school of nursing (required)
  • Minimum of 3 years’ clinical experience in an acute hospital setting (required)
  • Knowledgeable of and complies with accreditation and regulatory requirements
  • Obtains or ensures acquisition of appropriate pre-certification authorizations from third party payers and placement to appropriate level of care prior to hospitalization utilizing medical necessity criteria and third party guidelines
  • Documents, monitors, intervenes/resolves and reports clinical denials/appeals and retrospective payer audit denials
Qualifications for case management coordinator
  • Excellent interpersonal skills with demonstrated ability to work diplomatically with a wide variety of people
  • Ability to work effectively as a team leader, guiding the actions of others in order to accomplish team objectives
  • Strong organization and time management skills to work effectively in a fast paced environment with rapidly shifting priorities and competing demands
  • Current State of Florida RN or LPN
  • Prefer minimum two years clinical experience in an acute care
  • Minimum of 1 year discharge planning experience in acute care or healthcare setting
3

Case Management Coordinator Job Description

Job Description Example
Our growing company is hiring for a case management coordinator. We appreciate you taking the time to review the list of qualifications and to apply for the position. If you don’t fill all of the qualifications, you may still be considered depending on your level of experience.
Responsibilities for case management coordinator
  • Screen care management cases (condition management, disease management, ) to ensure information is complete and accurate
  • Interact with providers to monitor members discharge status disposition, to confirm member activity, to set up appointments, and other provider related activities
  • Assist in report production, data collection and data entry for care plan management
  • Arrange required services for the member
  • Manages all aspects of discharge planning for assigned patients and assures patients are discharged timely
  • Manages all aspects of the readmissions stratification, prevention and action planning
  • Refers patients/families and care givers to appropriate resources regarding abuse/neglect/domestic violence, alcohol and substance abuse
  • Performs appropriate clinical interventions related to grief counseling, bereavement, adjustment, crisis intervention in order to support the process of transition planning
  • Complex discharge planning and length of stay management experience or Bedside Nursing Experience
  • Knowledge of healthcare reform, government and third party reimbursement systems and contracts
Qualifications for case management coordinator
  • Working Knowledge of managed care and capitation operations
  • Organized with excellent verbal and written communication skills and computer literacy
  • Minimum 2 years of acute care case manager experience
  • Registered Nurse, Bachelor of Science in Nursing Degree preferred
  • Kaiser Case Management experience preferred but will train
  • BA/BS degree and nursing diploma required
4

Case Management Coordinator Job Description

Job Description Example
Our innovative and growing company is hiring for a case management coordinator. Thank you in advance for taking a look at the list of responsibilities and qualifications. We look forward to reviewing your resume.
Responsibilities for case management coordinator
  • Able to manage an inpatient complex discharge planning assignment up to 40 patients
  • Able to multitask, adapt to changing and multiple priorities
  • Acts as lead team member in the discharge planning process and primary responsible for identifying complicating social and financial factors and barriers to appropriate discharge
  • Facilitates consultation between referring patient-care providers and receiving physicians
  • Coordinates all communication between necessary staff at referring, receiving facilities, supportive and transportation agencies
  • Work in collaboration with multiple departments, physicians, nursing staff, Case management, Social Work, transportation agencies and durable medical equipment vendors
  • Partners with Case Management Team facilitating patient placement and managing discharge services that will promote quality outcomes
  • Evaluate patients referred for treatment to determine
  • Reviews daily admission roster to assure insurance carrier has been contacted and determine if clinical review is required to obtain insurance authorization
  • Receives all faxed requests for clinical information from payers, organizes and communicates to the appropriate member of the Case Management team
Qualifications for case management coordinator
  • Care facilitation and utilization review experience preferred
  • Managed Care experience preferred Case management and discharge planning experience
  • Bilingual in another language is a plus
  • Medical Assistant Certification or experience in a hospital discharge coordination environment strongly preferred
  • Must have VERY STRONG knowledge of medical vocabulary/terminology
  • Must be familiar with health plan/HMO/medicare guidelines
5

Case Management Coordinator Job Description

Job Description Example
Our growing company is searching for experienced candidates for the position of case management coordinator. Thank you in advance for taking a look at the list of responsibilities and qualifications. We look forward to reviewing your resume.
Responsibilities for case management coordinator
  • Answers the department phone and responds to voice mail in a timely manner
  • Monitors daily discharge report to assure all patient stay days are authorized
  • Maintains up to date concurrent authorization for in house patients
  • Assist in assuring proper patient status authorization, by reviewing patient admission status within the Cerner Care Manager system and matching with the correct authorization
  • Communicates with the other departments/team members for resolutions of conflicts between status and authorization
  • Immediately notifies the Case Manager and the Director of any inpatient denials and obtains information from the insurance carrier regarding their concurrent appeal process
  • Interacts with Physicians, office personal on an as needed basis to assure resolution of pending denials, which have been referred to the physician for peer-to-peer review with the Medical Director of the Insurance carrier
  • Adheres to HIPAA regulations by verifying pertinent information to determine caller authorization level before releasing account information
  • Follows up on requests for clinicals by insurance companies including faxing clinicals, discharge plans, returning phone calls and/or communicating any requested information for the purpose of securing authorization
  • Maintains a system for tracking insurance authorizations and following up when authorization is pending to assure that authorization is obtained without delay or denial
Qualifications for case management coordinator
  • This position requires strong verbal and written communication skills as you will be interacting with clinical leaders and staff
  • A Bachelor's degree in Social Work (BSW)
  • Experience and knowledge required in clinical guidelines, systems and tools , Milliman, Interqual
  • Bachelor's Degree in Health Services or Nursing or equivalent work experience is required
  • Intermediate competency in Excel such as proficiency with custom formatting spreadsheets, consolidated spreadsheets, PivotTables, data filtering, macros, and data security
  • Intermediate competency in PowerPoint such as proficiency with customization of PowerPoint environment, customize a design template, add diagrams to your presentation, add special effects to a PowerPoint presentation, use the various options to customize slide shows, use PowerPoint to publish slides to a slide library and secure your presentations

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