JFK Memorial Hospital has provided medical care to residents in the Coachella Valley since 1966. A group of physicians, including Dr. Reynaldo Carreon, founded the hospital and today one of JFK�s cross streets is named in his honor.

Originally called Indio Community Hospital, JFK has grown to a 145-bed acute-care hospital that is part of Tenet Healthcare California. It offers a variety of services, including:

• Emergency care 24/7
• Orthopedic and joint replacement services using emerging technology
• Cardiovascular services
• Maternity care and pediatric services
• Ambulatory surgery center
• Imaging services
• Outpatient Rehabilitation Center

Summary

The individual in this position works under direction of Social Worker or Case Manager RN.
The individual�s responsibilities include but not limited to the following actions:
Follow up on patient accounts for when authorization for stay is required
Fax numbers to Send clinical reviews
Follow up on each account during the stay and on discharge for authorization - document in the electronic system
Escalate any potential disputes or denial of accounts to director of Case Management or designee
Trends disputed claims by at least payor and physician (e assist in obtaining authorization for patient discharged to Skilled Facilities or other post acute care that require authorization)
Trend by payor and service any authorization not obtained by end of day
Trend and Track on denial prevention
Other duties as assigned

Responsibilities

Utilization Management

• Validates patientâ��s demographic and payer information with patient/family and notifies Patient Access immediately if any corrections are needed
• Validates that all commercial/managed care discharges have an authorization for status and level of care provided and notifies Director of Case Management (DCM) of variances
• Provides Important Message follow up letter to Medicare patients per Tenet policy and under the direction of the RN Case Manager or SW

Transition Management

• Makes referrals for post-acute services under the direction of the RN Case Manager or Social Work (SW) staff utilizing the electronic Tenet Case Management system
• Provides patients and families with choices of post-acute providers per Tenet policy
• Responds to post-acute providers timely and completes referrals per Tenet policy
• Documents and communicates all elements of the post-acute referral to the RN Case Manager or SW and the healthcare team, patient/family and post-acute providers
• Completes tasks as assigned by RN or LVN Case Manager and/or SW staff
• Makes copies, send faxes and complete phone calls to arrange post-acute services and to ensure that appropriate hospital information is communicated to post-acute providers
• Documents all referrals and tasks in the Tenet Case Management system per Tenet policy

Education

• Provides patients and healthcare team information regarding resources and benefits available to the patient along with the economic impact of care options

Compliance

• Adheres to federal, state, and local regulations and accreditation requirements impacting case management scope of services
• Adheres to department structure and staffing, policies and procedures to comply with the CMS Conditions of Participation and Tenet policies

Education

Required: High school graduate or equivalent
Preferred: Associates or bachelor's degree

Experience

Required: 2years of experience in clerical or healthcare field.
Preferred: Acute hospital or health plan experience.

Certifications

Preferred: Paramedic, EMT or Certified Nursing Assistant

Physical Demands

• Lift/position up to 25 lbs. Push/pull up to 25 lbs. of force.

• Frequent sitting. Moderate standing, walking, reaching, stooping, and bending.

• Manual dexterity, mobility, touch, auditory to perform all the related duties of the position.

Tenet complies with federal, state, and/or local laws regarding mandatory vaccination of its workforce. If you are offered this position and must be vaccinated under any applicable law, you will be required to show proof of full vaccination or obtain an approval of a religious or medical exemption prior to your start date. If you receive an exemption from the vaccination requirement, you will be required to submit to regular testing in accordance with the law.

Employment practices will not be influenced or affected by an applicant�s or employee�s race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other legally protected status. Tenet will make reasonable accommodations for qualified individuals with disabilities unless doing so would result in an undue hardship.