Fallon Health

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Inpatient Care Coordinator

Inpatient Care Coordinator

Job ID 
4879
# Positions 
1
Location 
US-MA-Worcester
Posted Date 
8/1/2017
Category 
Administrative/Clerical

More information about this job

Overview

About Fallon Health:

Founded in 1977, Fallon Health is a leading health care services organization that supports the diverse and changing needs of those we serve. In addition to offering innovative health insurance solutions and a variety of Medicaid and Medicare products, we excel in creating unique health care programs and services that provide coordinated, integrated care for seniors and individuals with complex health needs. Fallon has consistently ranked among the nation’s top health plans, and is accredited by the National Committee for Quality Assurance for its HMO, Medicare Advantage and Medicaid products. For more information, visit www.fallonhealth.org.

 

Summary:

The Inpatient Care Coordinator will follow Fallon Health  members in the inpatient setting using established business guidelines and with oversight from an UM Nurse.

Ensure accurate and timely data entry in the case management software system.

Effectively communicate with nurses, service coordinators, authoriztion Coordinators and vendors as necessary.

Responsibilities

      

  • Arrange for DME approved by the Inpatient UM nurse and UM department process.
  • Track elective, uncomplicated surgical cases for discharge dates and dispositon per established business guidelines and under the oversight of the UM Nurse.  
  • Refer identified cases to the appropriate per established business guidelines    
  • Adjust Inpatient/observation status changes per hospital notification process.
  • Provide team specific coverage.
  • Follow NICU patients per established business guidelines
  •  Manage uncomplicated members in DRG facilities under the oversight of the UM Nurse.

  •  Maintain the Memorial Hospital NICU census and enter clinical review of babies under the oversight from the assigned UM Nurse

  • SNF team - Assist with the Fast Track appeal process, Mass Health notification process, management of uncomplicated cases under the oversight of the UM Nurse.
  • Document business related notes in the case management software system note section.
  • Manage Maternity authorizations per the UM maternity process.
  • Manage observation authoriztions per UM observation process.
  • Assist with right fax renaming and assigning of notifications.
  • Provide assistance with authorization management and claims.

Qualifications

Education, Licenses, certification and experience requirements:

 

Education: College degree or equivalent preferred

 

License: Current MA Drivers License      

 

Certification: none      

 

Experience: 1-3 years job experience in a medical related field or with a healthcare payor company. Experience in a healthcare payor company a plus

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