What are the responsibilities and job description for the MANAGED CARE INPATIENT LIAISON position at St. Mary's Healthcare System for Children?
Managed Care Inpatient Liaison is responsible for obtaining initial and ongoing authorization for all inpatient programs throughout St. Mary's Hospital for Children. Supports Hospital's mission to provide the highest quality care by complying with regulatory guidelines, meeting agency standards, and obtaining appropriate certification.JOB DUTIES / RESPONSIBILITIES1. Responsible for insurance verification, pre-certification of cases and obtaining authorization for all contracted and non-contracted Managed Care Organization for all inpatient programs within St. Mary's Hospital for Children.2. Coordinates with all inpatient departments and referral sources to facilitate an admission.3. Provides needed documents and advocates to Managed Care Organizations to justify the appropriate level of care and to obtain ongoing authorization and / or needed denial for services provided.4. Obtains verbal reports from clinicians and generates Managed Care Summary Report for insurance companies, whenever needed.5. Responsible for the collection and documentation of all information related to insurance coverage and Managed Care Organizations in computer system.6. Coordinates with Social Workers and / or discharge planners on discharge planning, utilizing all programs within the system.7. Communicates all revenue code, levels and rate changes to the Billing Department.8. Reports level changes, not justified, to the Supervisor / Manager as soon as possible.9. Provides ongoing updates to Manager10. Coordinates peer to peer review when insurance wants to deny, initiating the appeals process.11. Works with Finance to rectify outstanding issues related to Managed Care Organization reimbursement.12. Runs managed care reports as needed13. Participates in departmental policy / procedure changes and completes tracking tools, as needed.14. Participates as member of the interdisciplinary team and attends family meetings and admission meetings.15. Responsible for covering for coworkers when out.16. Assists supervisor / manager, as needed.Formal education required : 1. LPN required, RN preferred.Previous experience required : 1. Some experience with utilization management and managed care required.2. Home care and / or pediatric experience a plus.3. Valid driver's license. Learn More
