Embark on a rewarding career with Baptist Medical Center hospital. If you are a compassionate healthcare professional eager to contribute to patient care, this is your opportunity where your skills make a difference every day. Join us in delivering exceptional healthcare with a personal touch.

At Baptist Medical Center, we understand that our greatest asset is our dedicated team of professionals. That’s why we offer more than a job – we provide a comprehensive benefit package that prioritizes your health, professional development, and work-life balance. The available plans and programs include:

• Medical, dental, vision, and life insurance
• 401(k) retirement savings plan with employer match
• Generous paid time off
• Career development and continuing education opportunities
• Health savings accounts, healthcare & dependent flexible spending accounts
• Employee Assistance program, Employee discount program
• Voluntary benefits include pet insurance, legal insurance, accident and critical illness insurance, long term care, elder & childcare, auto & home insurance

Note: Eligibility for benefits may vary by location and is determined by employment status

General Functions:
Utilization Management
 Validates patient’s demographic and payer information with patient/family and notifies Patient
Access immediately if any corrections are needed within 24 hours of admission
 Validates that all commercial/managed care discharge have an authorization for status and level of
care provided and notifies Director of Case Management (DCM) or designee of variances
 Escalates discharged cases at end of the day that have no authorization or notification or dispute is
provided by payor.
 Ensures, on a concurrent basis, that all clinical needed by payors and updates are provided by 100% alerting Case Manager assigned to case and escalating to DCM if not complete timely
 Trends dispute/denial potential to DCM or designee by failure points to revenue cycle
 Prepares denial information for UR Committee, Denial and Revenue Cycle Meetings
 Collaborates with Patient Access, Case Management, Managed Care and Business office to improve
concurrent review process to avoid denial or process delays in billing accounts.

Transition Management
 Follows up on Authorization for post-acute services
 Makes referrals for post-acute services under the direction of the RN Case Manager or Social (SW)
staff utilizing the Tenet Case Management documentation system..
 Follows-up if referral requires authorization by payor to discharge the patient
 Completes tasks as assigned by RN or LVN Case Manager and/or SW staff
 Makes copies, sends faxes and complete phone calls to arrange post-acute services and to ensure that
appropriate hospital information is communicated to post-acute serviced and to ensure that
appropriate hospital information is communicated to post- acute providers
 Documents all referrals and tasks in the Tenet Case Management documentation system per Tenet policy
 Provides Important Message follow-up letters to Medicare beneficiaries per Tenet policy and under
the direction of the RN Case Manager or SW 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 BHS/Tenet policies

Other:
 Utilizes resources efficiently and effectively
 Maintains safe environment
 Participates in Performance Improvement activities

This position may qualify for a sign-on bonus.

POSITION SUMMARY

The individual in this position works under the direction of the RN and/or Social Worker to complete referrals for post-acute services for patients, and assists with tasks that do not require a clinical license or degree. The individual’s responsibilities include the following activities: a) arrange post-discharge services; b) create and follow up on electronic referrals using the Tenet Case Management system; c) review patient choice letters with patients/families for required signatures; d) provide follow up Important Message to Medicare
patients prior to discharge; e) communicate with patients, families and other members of the care team; f) complete tasks assigned by Case Manager and Social Work staff; g) make copies, send faxes and complete phone calls; h) complete process reviews or audits as requested; and i) other duties as assigned.

MINIMUM EDUCATION: High School diploma or equivalent
PREFERRED EDUCATION: Associate’s or Bachelor’s Degree from an accredited college
MINIMUM EXPERIENCE: 2 years of experience in clerical or healthcare field. Possesses excellent organizational,
verbal/ written communication skills, problems solving and computer literacy skills. Data Analytics skills.
PREFERRED EXPERIENCE: Acute hospital experience
REQUIRED CERTIFICATIONS/LICENSURE: NA
PREFERRED CERTIFICATIONS/LICENSURE: Paramedic, EMT or Nursing Assistant certifications.
REQUIRED COURSES/ COMPLETIONS (e.g., CPR): NA

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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.
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The employment practices of Tenet Healthcare and its companies comply with all applicable laws and regulations.