Summary:

Reports to the Manager and Supervisor of Discharge Planning. As a member of a multidisciplinary team and in consultation with the Coordinated Care Manager and Transition Care Coordinator secures post-acute prior authorizations. Functions as a liaison between patient/hospital and outside agencies regarding the authorization process. 

Responsibilities:

Responsible for day-to-day management of prior authorizations for patients discharging to post-acute providers (i.e. nursing homes and acute rehabs).

Communicates with hospital discharge planning team insurance companies and post-acute providers.

Maintains knowledge of the discharge planning process.

Communicates barriers to securing post-acute prior authorizations to leadership and the discharge planning team.

Communicates approvals and denials received in a timely manner.

Assists with the initiation of the internal peer to peer review process for denials received.

Documents progress with the post-acute prior authorization process and ensures all relevant information is captured.

Builds relationships and ensures effective communication with internal and external providers to ensure clarity of prior authorization issues.

Manages multiple priorities and maintains high quality of work in a fast-paced environment.

Participates in process improvement of the post-acute prior authorization process.

Participates in ongoing independent study education-related professional activities and affiliations to maintain knowledge of third-party payors managed care requirements and discharge planning.

Other information:

BASIC KNOWLEDGE:

Bachelor�s Degree with a concentration in health services health education or business administration is preferred.

Level of knowledge in healthcare delivery systems and services clinical issues discharge planning processes third party payer regulations and the like such as may have been obtained through experience in such roles as social worker discharge planner case manager or similar position.

Knowledge of medical terminology is preferred.

Demonstrated knowledge and skills in consideration of aging processes human development stages and cultural patterns.

EXPERIENCE:

One year of current relevant healthcare professional experience in healthcare setting or human service agency.

A basic proficiency in the use of Microsoft office software programs including email and outlook calendar and basic keyboard skills are also required.

Experience with managed care desirable.

Knowledge of health care and health care delivery systems.

WORK ENVIRONMENT AND PHYSICAL REQUIREMENTS:

General hospital environment with occasional exposure to patient care environments.

Must be able to make hospital rounds through various patient care areas either by walking or through some other mobile means.

Visual acuity and finger dexterity is needed to review medical records navigate through automated system screens and type on a typical computer terminal keyboard.

Must be able to lift and or carry up to 10 lbs. in order to transport items from one patient care unit to the next.

SUPERVISORY RESPONSIBILITY:

None.

Brown University Health is an Equal Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race color religion sex national origin age ethnicity sexual orientation ancestry genetics gender identity or expression disability protected veteran or marital status.   Brown University Health is a VEVRAA Federal Contractor.

Location: The Miriam Hospital USA:RI:Providence

Work Type: Full Time

Shift: Shift 1

Union: Non-Union

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