Blending
Care
and Expertise
Case Management Support Specialist
Location: Philadelphia, Pennsylvania
Date Posted: 19 May, 2023
Position Summary:
"Pharmacy Tech background is highly preferred"
Under the Direction of the Case Management Supervisor, the Support Specialist collaborates closely with the case management staff to provide a coordinated experience to patients and families.
The primary responsibilities are to perform selected services and functions related to patient care coordination, utilization review, discharge planning and data collection for the Case Management Department.
This includes benefit checks, obtaining authorization for transportation, prior authorizations for medications, DME, and facility placement.
Ensures timely faxing of clinical reviews, payor communications, and data entry of payor authorizations.
Utilization Management:
Monitors computer system for admission and continued stay insurance authorizations notifying the Case Manager when a clinical update is needed.
Follows through with verification for insurance coverage, authorized days and benefits as directed by the case manager.
Assists case manager with submission of clinical reviews to appropriate review agencies and documents in the EHR.
Records payer authorizations in the EHR.
Notifies case manager of authorization/denial updates.
Processes mail delivered daily to the department.
Monitors faxes as they are delivered to the various Case Management email accounts and in-office fax machines.
Transcribes voicemails from the department voicemail box.
Monitors Epic Failed Fax In-Basket.
Contact payers for authorization updates.
Files hard copy correspondence accordingly as it is received.
Discharge Planning:
Obtains authorizations for the following post-discharge services and documents the status in the EHR:
Medication authorizations
Transportation authorizations
Facility and DME authorizations
Arranges ambulance or medical transportation.
Provides support to the discharge coordination process.
Completes benefit checks as needed.
Conducts discharge follow-up patient phone calls.
Able to elicit information during follow-up calls and understands when to have case manager intervene.
Accurately and promptly documents interventions appropriately.
Communicates professionally and establishes effective working relationship with internal external customers.
Document status of discharge planning in the EHR.
Send/fax records to post-acute providers as needed.
Prior Authorization:
Provides pharmacy benefit information to the patient and clinical team that includes but not limited to eligibility, expected out-of-pocket expenses, and co-pay assistance programs.
Assists with appeals of any denied prior authorizations.
Documents status of medication prior authorization in the EHR.
Execute prior authorization via Cover My Meds when appropriate.
Works collaboratively with the Case Manager to ensure all discharge medications requiring prior authorization are processed timely.
Data Management:
Runs case management related reports.
Monitors, identifies and communicates trends in payor responses to authorizations requests and advances learning to manager.
Other duties as assigned.
Preferred Education:
Bachelor’s degree
Preferred Experience:
Two (2) years of experience with medication prior authorizations
Two (2) years of progressively responsible administrative support experience in an academic, scientific or medical setting
Preferred Licenses/certificates/registrations:
PTCB (Pharmacy Technician Certification Board) or NCCT (National Certified Pharmacy Technician).
-Level 4 worker
Education: Bachelors Degree
Certification: National Certified Pharmacy Technician
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