Case Management Assistant - Einstein Montgomery

Job Details

Job Description

Works under the direction of the Manager of Case Management and Case Manager RN to provide assistance with the utilization review process, including communicating clinical information/reviews to third party payers to ensure certification/approval of inpatient and post-hospital services. Assists with the coordination of post hospital care and service arrangements.

* Interacts with co-workers, visitors, and other staff consistent with the values of Jefferson.
* Negotiates with payers to obtain authorization for appropriate level of care and length of stay.
* Responsible for meeting insurer timeframes regarding review of clinical information.
* Provides prompt feedback regarding denials and other payer determinations to the Case Manager RN and Physician Advisor.
* Obtain payer authorization and coordinate identified homecare, Durable Medical Equipment (DME), transportation, infusion services and post-acute services for all identified patients.

Work Shift

Worker Sub Type

Primary Location Address

Nationally ranked, Jefferson, which is principally located in the greater Philadelphia region, Lehigh Valley and Northeastern Pennsylvania and southern New Jersey, is reimagining health care and higher education to create unparalleled value. Jefferson is more than 65,000 people strong, dedicated to providing the highest-quality, compassionate clinical care for patients; making our communities healthier and stronger; preparing tomorrow's professional leaders for 21st-century careers; and creating new knowledge through basic/programmatic, clinical and applied research. Thomas Jefferson University, home of Sidney Kimmel Medical College, Jefferson College of Nursing, and the Kanbar College of Design, Engineering and Commerce, dates back to 1824 and today comprises 10 colleges and three schools offering 200+ undergraduate and graduate programs to more than 8,300 students. Jefferson Health, nationally ranked as one of the top 15 not-for-profit health care systems in the country and the largest provider in the Philadelphia and Lehigh Valley areas, serves patients through millions of encounters each year at 32 hospitals campuses and more than 700 outpatient and urgent care locations throughout the region. Jefferson Health Plans is a not-for-profit managed health care organization providing a broad range of health coverage options in Pennsylvania and New Jersey for more than 35 years.

Jefferson is committed to providing equal educational and employment opportunities for all persons without regard to age, race, color, religion, creed, sexual orientation, gender, gender identity, marital status, pregnancy, national origin, ancestry, citizenship, military status, veteran status, handicap or disability or any other protected group or status.