What are the responsibilities and job description for the Managed Care Coordinator position at St. John's Riverside Hospital?
Overview
St. John's Riverside Hospital is a leader in providing the highest quality, compassionate health care utilizing the latest, state-of-the-art medical technology. Serving the Westchester community from Yonkers to the river town communities of Hastings-on-Hudson, Ardsley, Dobbs Ferry and Irvington, St. John's Riverside has been and continues to be a unique and comprehensive network of medical professionals dedicated to a tradition of service that spans generations.
St. John’s has been an integral part of the community since the 1890's and its’ commitment to provide the community with the most advanced medical services available continues to be the hospitals’ vision, mission and value. St. John's Riverside Hospital built itself around an early foundation of nursing and community service. In 1894, the Cochran School of Nursing, the oldest hospital-based school of nursing in the metropolitan area, was founded, thus making the St. John's Nursing Staff more than just the backbone of the hospital, but the heart and soul. St. John’s dedicated nurses give superior attention to those who need it most with a strong emphasis on patient and family-focused nursing care.
St. John’s Riverside Hospital staff is committed to making life better for all patients. The hospital continues to elevate the services provided with the goal of increasing the quality of life for all who entrust St. John's Riverside Hospital to their care.
Personalized care together with advanced technology is what it means to be Community Strong
Responsibilities
The Managed Care Coordinator will coordinate the provision of inpatient chemical dependency treatment services with third party payers, including commercial insurers and managed care companies. He/She will coordinate inpatient care with other assigned staff through entire treatment cycle. Facilitate authorization and concurrent review processes for all third party insured inpatients. Perform comprehensive psychosocial assessments on prospective patients, as needed. Work collaboratively and manage all relevant information from medical, nursing, and counseling staff needed to present patient case to insurance entities to attain proper authorization for patient stays. Maintain and disseminate updated insurance entity information including changes in managing entities, plan changes, hours of operation, contact information and all other relevant information with regards to authorization policies and procedures. Work in conjunction with BHS Central Intake staff on coordination of patient’s insurance benefits. Performs care management functions for inpatients, as needed. Maintain relationships with other agencies and individuals wishing to make referrals to the program; coordinate discharges as needed. Remain current on policies and procedures of insurance companies to facilitate coordination of program’s financial responsibilities. Maintain and prepare statistical data, reports, and correspondence as required for agency, county and state, as assigned. Maintain clinical records in compliance with all regulatory bodies and SJRH/BHS policies and procedures.
Qualifications
CASAC, LMSW, LMHC or other NYS recognized QHP required. Five or more years of treatment experience specific to chemical dependency treatment is required; inpatient detoxification and rehabilitation experience preferred. 3-5 years of experience dealing with managed care/ insurance companies is required.
