Care Integration Specialist

Department Overview:

This position functions under the direct supervision and management of the Care Integration Manager. Activities are related to discharge plan coordination, insurance utilization to ensure hospitalizations are covered, external resources for discharge, and general support of the department employees.

Pay Range: $29.96 - $40.50 per hour

Function/Duties of Position:

Utilization Management:

• Reviews Admitting/IVS comments in EPIC, approved length of stay, clinical review due date, and insurance company UR contact information in Payor Comm of EPIC to minimize miss communication when coordinating resources.
• Calls appropriate OHSU or outside personnel to locate missing authorization number, approved length of stay, clinical review due date, and insurance company UR contact information to ensure resources are covered for post-acute coordination.
• Collects and organizes data related to clinical condition and treatment plan for use in utilization review by communicating with insurance providers. If denied, collaborates with treatment team to create a new plan.
• Faxes clinical information to third party payers, when allowed by payer, in order to obtain authorization for continued stay and discharge resources. Notifies Case manager when phoned clinical information is required otherwise, resources are determined and coordinated based on coverage.

Care Coordination:

• Review daily EPIC patient list with care management/treatment team to proactively create a discharge plan for the patient or relay any progress.
• Prioritize patients’ needs prior to discharge based on coverage, social needs, medical needs and so on.
• Own discharge plan and help determines available resources for patients throughout their stay and relays this information to the patient/treatment team.
• After the treatment team identifies potential medical discharge needs, this information is taken and used to create an appropriate discharge plan by discussing with the patient, utilizing the resource guide and connecting with external vendors of what is safest and possible.
• Facilitate initiation of other appropriate services such as meal cards, AFS checks, family housing, etc.
• Follow the patient’s progress with the multidisciplinary team by way of rounds to identify key points within the patient’s care to independently start the discharge coordination process. This information will be documented within epic via the case management module or a note.
• Acts as a liaison between all care team members, updating each of the progress of the discharge plan and any potential barriers. This information will also be documented in epic via the case management module or note.
• Connect with patients regarding preference, changes, confirmation of services arranged and any additional updates or questions.
• Calls, photocopies, faxes, or mails clinical and referral information based on the resource guide to set up post-acute services which can include:
• Home Health and Hospice agencies
• Infusion vendors
• DME vendors
• Transportation vendors
• SNF, ICF, AFH, RCF, and Assisted Living facilities
• Shelter operators
• Outside Case Managers
• Medicaid Caseworkers
• Insurance companies
• Types letter of medical necessity, if needed
• Follow up with any services arranged such as referrals/ insurance companies to ensure resources are obtained.
• Document all services arranged, referrals and continuous updates in epic via the case management module or a note.
• Arrange or identify follow up appointments post discharge including new, PCP, specialties, lab, radiology, etc. to prevent hospital readmissions.
• Other duties related to discharge without a requirement of a license.

Miscellaneous:

• Supports budget analysis needs of Director
• Create, update and maintain the Resource Guide Directory used for care coordination. This include all post-acute services, insurance coverage information, provider information and more.
• Track data for the organization related to discharge planning and care coordination
• Reports identified QA/PI issues to appropriate person
• Uses critical thinking skills for process improvement
• Processes payments/deposits for patient care needs (Oracle, Journal Entries, disbursements and depots)
• Creates and maintains forms and databases needed
• Assists with back-up for CM clerical staff, as needed
• Participates in orientation of new employees (training)
• Length of stay reporting/data extraction

Required Qualifications:

• Associate degree in a healthcare related field that may include such areas as nursing, community health education, psychology or sociology is required.
• Minimum two (2) years of healthcare setting, such as hospital, clinic or health plan, experience is required.
• Prior experience in case management in a health care setting, such as hospital, clinic or health plan is preferred.
• Demonstrated excellent written and verbal communication skills.
• Experience working with patients and their families.
• Must be flexible, self-motivated, proficient at multitasking, accustomed to frequent interruptions, and comfortable with change.
• Must be knowledgeable in medical and insurance terminology and procedures, and patient discharge process. Familiarity with insurance UR and disability qualifications.
• Able to work independently with minimal oversight
• Must have time management skills with competing priorities.
• Able to maintain a commitment to their coworkers
• Demands critical thinking
• Requires knowledge of Microsoft Office Excel, Word, PowerPoint, and Outlook.
• Ability to perform the job duties with or without accommodation.

Preferred Qualifications:

• Bachelor’s degree in a health care related field that may include such areas as community health education, psychology or sociology is preferred.
• Prior experience in case management in a health care setting, such as hospital, clinic or health plan is preferred.
• EPIC software
• Kronos timekeeping software
• Crystal Reports software

Individuals with diverse backgrounds and those who promote diversity and a culture of inclusion are encouraged to apply. To request reasonable accommodation contact the Affirmative Action and Equal Opportunity Department at 503-494-5148 or aaeo@ohsu.edu.