I. General Summary

* A Case Management Technician is responsible for supporting the core functions of discharge planning and utilization management, and carrying out associated routine tasks. These tasks include assisting with arrangement of post discharge resources such as returns to nursing home, home care, DME, and transportation services. The role also assists with communication between the hospital, customers and payors through phone, fax, notifications and data entry. The technician works under the direction of a licensed RN Care Manager or Social Worker.

II. Principal Responsibilities and Tasks

* Assists the Case Management team with post-acute set up.

* Arranges transportation for patient discharging via ambulance/wheelchair van.

* Makes referrals to home care agencies via CCSC in EPIC under the guidance of a Case Manager or Social Work partner.

* Works effectively with external providers through good communication, completes documentation and follow-through to ensure efficient and smooth transition for the patient.

* Effectively communicates with the healthcare team regarding discharge planning activities and status.

* Assists with the distribution of the Important Message from Medicare discharge notice and MOON per policy.

* Monitors all referrals made through EPIC. * Submits insurance authorizations via fax/insurance portals.

* Prints reviews and sends reviews through fax to payors within allotted timelines.

* Ensures Payor satisfaction through positive and effective communication.

* Responsible for logs for clear communication with payers and UM team.

* Provides follow up to UM team on approvals and denial, peer to peer information.

* Monitors commercial reviews through daily census reports, and payor logs to avoid denial of payment to the hospital