Care Management Assistant HHC

• Monitor Task Report, respond to request from billing, insurance verification and service office.
  •     1)Obtain documentation for Prior Approval Request on patients with HFS insurance.
  •     2)Contact Clinical Manager on any urgent issues or patients were documentation does not support projected number of visits.
• Track clinical updates for timely submission of written documentation to Enterprise Care Managers (ECM)
  •     1)Identify ECM through Active Advice
  •     2)Submit appropriate documentation to ECM upon patient discharge from Home Health.
  •     3)Submit additional documentation upon request to ECM for AdvocateCare patient population.
• Verification of authorized visits versus visits made and visit frequency on specified payers. Reporting of final visit numbers to external case manager.
  •     1)At specified times (i.e. discharge and recertification), review and match actual visits to authorized visits, coummunicate visit summary to external case manager.
  •     2)Notify internal Case Manager of any discrepanies.
• Obtain Plan of Treatment and/or Supplemental Orders to support request for Prior Approval on patients with HFS health plan.
  •     1)Track supplemental orders to obtain prior authorization from HFS on ALL therapies.
• Communicate authorized visits to contracted vendors on HFS patients. Monitor contracted therapy vendors for over utlization and unauthorized services.
• Other Duties as assigned
  •     1)Assist Case Managers with documentation process as needed

This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.