Job Description

Location: Sharon Regional Medical Center
Posted Date: 10/14/2021

At Sharon Regional Medical Center, we are committed to improving the health of our communities by delivering exceptional, personalized health care with dignity, compassion, and respect. Our Continued focus on the patient experience informs our caregivers in how to provide care that is respectful of and responsive to individual patient and family preferences, needs and values.

We dedicate ourselves in the communities we serve to delivering affordable health care to all and being responsible partners. No matter what your role, as a member of the Steward family, you are a specialist in the making every patient and family feel right at home, every co-worker a key to our success, and every referring practice, a team of prized colleagues.

In support of this, we commit ourselves to the following values:

Compassion

Accountability

Respect

Excellence

Stewardship

If you are seeking a fast-paced, challenging position in an organization committed to achieving and maintaining a standard of excellence in all we do, our organization may be a good fit for you.

Job Summary:

The Case Management Coordinator serves as the central point person for all clinical denial mitigation activities within the market in collaboration with the facilities. Provides guidance, support, and oversight to ensure effective management of the proactive and retrospective workflow and response processes.

Job Responsibilities:

  • Responsible for analyzing, facilitating, and coordinating the denials mitigation process including developing and maintaining a database of analysis / audit records, tracking, and trending denials.
  • Provides outcome reports to facility and corporate leadership
  • Assists with coordination and facilitation at Joint Operating Committees.
  • Has knowledge of CMS (Center of Medicare and Medicaid Services) regulations, commercial review criteria application, utilization review/medical necessity documentation processes, common managed care medical management operations processes and coverage determinations, as well as processes for denials mitigation and appeals.
  • Coordinates the analysis of denial, Peer to Peer, and appeal activity.
  • Must possess excellent written and verbal communication skills. Requires strong interpersonal skills in working with physicians and staff.
  • Developing and maintaining accurate data for key drivers for Utilization review

Requirements:

  • High School Diploma or equivalent
  • Current BLS or obtained within 90 days of hire
  • Preferred 2 years’ experience with authorization management
  • Familiar with standard concepts, practices, and procedures within a particular field
  • Background clearances (as required by law).

Benefits:

  • Medical, Dental and Vision
  • 401K
  • Vacation time and Sick time

Please note, our Sharon Regional Medical Center is taking additional, necessary preparations to ensure patients can receive compassionate care in a safe, carefully managed environment - with confidence and without fear. Our Safe and Ready program consists of a rigorous [five-point] standard ensuring patient safety, confidence, and convenience: Expanded hours will allow previously cancelled procedures to be scheduled as quickly as possible. Any COVID-19 related care takes place in designated areas away from other patients and their family. Emergency Departments are reorganized to be a safe place to treat all emergency patients. A stringent cleaning policy is required for patient safety. You can rest assured that we have made the necessary preparations to provide care in a safe, controlled, and professional way.

Steward Health Care is an Equal Employment Opportunity (EEO) employer. Steward Health Care does not discriminate on the grounds of race, color, religion, sex, national origin, age, disability, veteran status, sexual orientation, gender identity and/or expression or any other non-job-related characteristic.

Application Instructions

Please click on the link below to apply for this position. A new window will open and direct you to apply at our corporate careers page. We look forward to hearing from you!

Apply Online