Department: Case Management

Schedule: Full-time

Facility: Holy Family Medical Center

Location: Des Plaines, IL

Serves as the operational lead for LTACH admissions and referral management. Conducts screening and clinical reviews of patients for LTACH appropriateness. Identifies in-system patients who may benefit from LTACH level of care and facilitates follow-up to ensure care providers are aware of this option for continued patient management. Collaborate with physicians, case managers, hospital leadership, and clinical liaisons, to coordinate patient transition to LTACH. Works closely with managed care payors to obtain prior authorization and to facilitate timely transfer when patients are medically appropriate.

Completes intake processes including providing information about hospital services and programs. Coordinates tours, referrals, and prior authorizations. Communicates directly with managed care providers to coordinate peer to peer discussions and follow-up for cases that are denied. Retrieves referrals, initiates a pre-admission encounter, and assigns each referral to appropriate clinical liaisons. Maintains updated information for each referral on the daily referral log. Facilitate admissions with clinical leadership team, finance department, and case management. Assure authorizations are accurate or updated and provide corresponding insurance information to the business office, case management, and physicians. Responsible for entering and maintaining accurate registration, admission, and discharge data. Maintains statistics related to referral and admission volumes as well as other departmental data. Responsible for other duties as assigned.

EDUCATION, EXPERIENCE, TRAINING

·       Medical Graduate, Dental Graduate, PA, or Nursing Graduate required. 

·       Two years of experience in a hospital setting.

·       Experience in Utilization Review/Management preferred.

·       Knowledge of InterQual and Milliman and or InterQual criteria preferred.

·       Healthcare management experience preferred.

·       Knowledge of reimbursement and managed care structures preferred.

Holy Family Medical Center offers competitive compensation and a comprehensive benefits package that provides employees the flexibility to tailor benefits according to their individual needs. Our Total Rewards package includes, but is not limited to, paid time off, a 401K retirement plan, medical, dental, and vision coverage, tuition reimbursement, and many more voluntary benefit options. A reasonable compensation estimate for this role, which includes estimated wages, benefits, and other forms of compensation, is $84,281.60 to $113,422.40 on an annualized basis. The exact starting compensation to be offered will be determined at the time of selecting an applicant for hire, in which a wide range of factors will be considered, including but not limited to, skillset, years of applicable experience, education, credentials and licensure.

The company is dedicated to empowering its staff with a comprehensive, competitive benefits package, allowing them the freedom to customize their benefits to fit their unique needs. Our abundant resources, programs, and voluntary options serve as a foundation for individual growth and well-being. Learn more here: https://www.primehealthcare.com/benefitsthatmattermost/