• 2302205

JOB SUMMARY:

Collaborates with the home health care team to coordinate patient home care across the continuum of home care by requesting authorization for patient visits. Serves in an advocacy role on behalf of patients, families, and caregivers to ensure safe, equitable healthcare provision. Assists in developing and meeting key Pillar outcomes and system improvement goals including financial, satisfaction, and clinical as the Home Care Managed Care Coordinator.

The main objective of the Managed Care Coordinator is to verify patient insurance plan coverage for home care benefits and determine prior authorization for reimbursement of care. Daily responsibilities include: Verify insurance on all new referrals, secure authorizations on all new referrals and communicate to the clinical team leads regarding authorization, visit limitations or exceptions.

Position Shift:

• Full time, Monday - Friday
• Office hours 8:00am to 4:30pm
• MCO orientation - one day
• Home Care orientation - six weeks in the office (remote upon completion)

Department/Unit Summary

Vanderbilt Home Care is part of one of the country’s most respected medical centers. We provide in-home care for patients with chronic conditions.

Click here to learn more about the benefits of a career with Vanderbilt Home Care.

Bringing Vanderbilt Care into Your Home Since 1985

Vanderbilt Home Care provides caregivers in the patient's own environment under the direction of the patient's physician. When you or your loved one receives care from Vanderbilt Home Care, you are in the hands of highly skilled, compassionate individuals. We take pride in our work and feel privileged to be part of one of the country's most respected medical centers.

Our Mission and Values:

Our mission is to provide excellence in home care with the high standards that we would expect for our own family and loved ones. Our values include:

• Support for community based home services through excellence in clinical practice and education
• Patient safety and quality
• Strong interdisciplinary collaboration, communication and partnership
• Evidenced based practice and clinical expertise
• Technology enhanced innovation

The Home Health Quality team is a small task oriented team which consists of a quality educator, a quality data analyst, and quality reviewer. They work closely together with clinical managers to provide meaningful data on home health patient population and clinician best practices.

Discover Vanderbilt University Medical Center:

Located in Nashville, Tennessee, and operating at a global crossroads of teaching, discovery and patient care, VUMC is a community of individuals who come to work each day with the simple aim of changing the world. It is a place where your expertise will be valued, your knowledge expanded and your abilities challenged. It is a place where your diversity — of culture, thinking, learning and leading — is sought and celebrated. It is a place where employees know they are part of something that is bigger than themselves, take exceptional pride in their work and never settle for what was good enough yesterday. Vanderbilt’s mission is to advance health and wellness through preeminent programs in patient care, education, and research.

VUMC Recent Accomplishments

Because we are committed to providing the best in patient care, education and research, we are proud of our recent accomplishments:

• US News & World Report: #1 Hospital in Tennessee, #1 Health Care Provider in Nashville, #1 Audiology (Bill Wilkerson Center), 12 adult and 10 pediatric clinical specialties ranked among the nation's best, #15 Education and Training
• Truven Health Analytics: among the top 50 cardiovascular hospitals in the U.S.
• Becker's Hospital Review: one of the "100 Greatest Hospitals in America"
• The Leapfrog Group: grade "A" in Hospital Safety Score
• National Institutes of Health: among the top 10 grant awardees for medical research in the US
• Magnet Recognition Program: Vanderbilt nurses are the only group honored in Tennessee
• Nashville Business Journal: Middle Tennessee's healthiest employer
• American Hospital Association: among the 100 "Most Wired" medical systems in the US

KEY RESPONSIBILITIES:

• Request authorizations for Home Health Care from insurance carriers, through whatever method is optimal and the most efficient and effective for that carrier.
• Obtain Start of Care (SOC) authorization.
• Obtain Add-on prior authorization, obtain prior authorization for Resumption of Care (ROC), obtain concurrent authorization.
• Enter authorization request responses.
• Case Management Advocacy.
• Review written off no authorization (wona) requests from billing team for possible.
• Confer with other MCC's, brainstorm on any new payer process changes, and update Payer Auth Requirement document
• Review and respond to all messages from all staff including concurrent authorization requests/payer questions.
• Review and responds timely to all billing company communication through our “Jira” tool and effectively minimizes the outstanding “Jira” messages in their work que.
• Review and correct process errors from authorization Edit reports.
• Review validation report errors.
• Review and respond timely to Outlook messages and voice mail messages and review Outlook calendar reminders.
• The responsibilities listed are a general overview of the position and additional duties may be assigned.
• Demonstrates leadership skills and acts as the key information and education resource for the interdisciplinary team as related to insurance authorization needs and securing appropriate services.
• Integrates ethical provisions in all areas of the practice.
• Deep dive analyses of insurance denials and authorization requests, using excel spreadsheet for data tracking.

Position Requirements:

• Bachelor's Degree
• 5 years relevant experience

Strongly Preferred by Department:

• Medical background
• Insurance background
• Medical Terminology
• Excellent computer skills
• Excellent communication/inpersonal skills
• Highly organized

Physical Requirements/Strengths needed & Physical Demands:

• Light Work category requiring exertion up to 20 lbs. of force occasionally and uses negligible amounts of force to move objects.

Movement

• Occasional: Standing: Remaining on one's feet without moving.
• Occasional: Walking: Moving about on foot.
• Occasional: Lifting under 35 lbs: Raising and lowering objects under 35 lbs from one level to another
• Occasional: Lifting over 35 lbs: Raising and lowering objects from one level to another, includes upward pulling over 35 lbs, with help of coworkers or assistive device
• Occasional: Carrying under 35 lbs: Transporting an object holding in hands, arms or shoulders, with help of coworkers or assistive device.
• Occasional: Push/Pull: Exerting force to move objects away from or toward.
• Occasional: Bending/Stooping: Trunk bending downward and forward by bending spine at waist requiring full use of lower extremities and back muscles
• Occasional: Balancing: Maintaining body equilibrium to prevent falling when walking, standing, crouching or maneuvering self, patient and equipment simultaneously while working in large and small spaces
• Occasional: Climbing: Ascending or descending stairs/ramps using feet and legs and/or hands and arms.
• Occasional: Kneeling:Bending legs at knees to come to rest on knee or knees.
• Occasional: Crouching/Squatting: Bending body downward and forward by bending legs and spine.Reaching above shoulders: Extending arms in any direction above shoulders.
• Occasional: Reaching above shoulders: Extending arms in any direction above shoulders.
• Occasional: Handling: Seizing, holding, grasping, turning or otherwise working with hand or hands.
• Occasional: Bimanual Dexterity: Requiring the use of both hands.
• Frequent: Sitting: Remaining in seated position
• Frequent: Reaching below shoulders: Extending arms in any direction below shoulders.
• Frequent: Fingering: Picking, pinching, gripping, working primarily with fingers requiring fine manipulation.

Sensory

• Continuous: Communication: Expressing or exchanging written/verbal/electronic information.
• Continuous: Auditory: Perceiving the variances of sounds, tones and pitches and able to focus on single source of auditory information
• Continuous: Vision: Clarity of near vision at 20 inches or less and far vision at 20 feet or more with depth perception, peripheral vision, color vision.
• Continuous: Smell: Ability to detect and identify odors.

Environmental Conditions

INDTR

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