Case Management Associate at Partner's Healthcare in Cambridge, Massachusetts

Job Description:

Site: The Spaulding Rehabilitation Hospital Corporation


At Mass General Brigham, we know it takes a surprising range of talented professionals to advance our mission-from doctors, nurses, business people and tech experts, to dedicated researchers and systems analysts. As a not-for-profit organization, Mass General Brigham is committed to supporting patient care, research, teaching, and service to the community. We place great value on being a diverse, equitable and inclusive organization as we aim to reflect the diversity of the patients we serve.


At Mass General Brigham, we believe a diverse set of backgrounds and lived experiences makes us stronger by challenging our assumptions with new perspectives that can drive revolutionary discoveries in medical innovations in research and patient care. Therefore, we invite and welcome applicants from traditionally underrepresented groups in healthcare - people of color, people with disabilities, LGBTQ community, and/or gender expansive, first and second-generation immigrants, veterans, and people from different socioeconomic backgrounds - to apply.



Job Summary
Reporting to the Manager of Case Management and working under the direction of the Case Managers (CM) and Social Work (SW) staffs, the Case Management Associate provides support to Case Managers and Clinical Social Workers with routine and regulatory clinical and administrative functions.



Qualifications



Key Responsibilities:



• Provides administrative support related to the discharge process through faxing, copying, and scanning of information, including but not limited to referral sources, insurers, PCP offices; booking rooms for family-team meetings; assisting patients with securing new PCP's prior to discharge; researching DME providers.


• Supports the process of patient referral to SNF, home care, and outpatient. The referral process includes entering clinical information into the 4NEXT referral system and managing the communications regarding acceptance and bed offer or denial with facilities; referrals to outpatient via SharePoint; and contacting home care agencies via telephone with pre-referral information and to establish a start of care date; initiating the patient care referral paperwork.


• Supports the insurance authorization and continued stay process by making initial contact with the insurance CM to confirm contact information and to establish contacts between the payer and SRH CM; submitting fax and online requests for continued stay authorization and monitors the decision from the payer.


• Researches available community resources at the request of the CM or SW.


• Assists the CM, SW, patient and/or family with applications for community resources, such as PT1, handicap placards, and specialized funds.


• Maintains a database for insurance-based processes, e.g. denials and appeals, Medicaid conversion requests and decisions.


• Contacts patients after discharge to home to complete the "Post Discharge Follow-up Phone Call" process and documents the calls per department protocol.


• Other duties will be assigned.



Qualifications and Experience




Education/Degree



Required


Preferred


• Bachelor's of Social Work from an accredited institution preferred. However, would substitute experience and complimentary of Associate Degree



Experience



Required


• A minimum of 1-2 years of clinical and/or community resource experience required



Skills (Specific learned activity gained through training (e.g. computer skills, keyboarding, presentation, CPR, ACLS, etc.)

• Computer proficiency required. Microsoft office applications preferred with ability to learn new software.


• Highly developed communications and interpersonal skills, working with diverse population.


• Work independently, be self-directed and contribute as a member of a team.


• Anticipates challenges and develops and implements strategies for addressing them.


• High level of service delivery. Demonstrate initiative with ability to prioritize work, meet deadlines and adapt to changing situations.


• Attention to detail.

Additional Job Details (if applicable)



Remote Type


Onsite



Work Location


1575 Cambridge Street



Scheduled Weekly Hours


40



Employee Type


Regular



Work Shift


Day (United States of America)



EEO Statement:


The Spaulding Rehabilitation Hospital Corporation is an Affirmative Action Employer. By embracing diverse skills, perspectives and ideas, we choose to lead. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment.



Mass General Brigham Competency Framework


At Mass General Brigham, our competency framework defines what effective leadership "looks like" by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People-Focused, half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance, make hiring decisions, identify development needs, mobilize employees across our system, and establish a strong talent pipeline. Apply Now