As a Case Management Resource Specialist, you will work collaboratively with the Complex Care Nurse Managers, Clinical Care Coordinators, and Utilization Review Nurses, assuming all administrative responsibilities within the discharge planning, referral management, and utilization review processes. Perform other duties as needed and assigned by your supervisor. DUTIES AND RESPONSIBILITIES: + Provides direct support to Complex Care Nurse Managers on clinical units, verifies patient demographic information including address, telephone number and insurance information, and advance directives. + Queries patients to past Visiting Nurse Agency (VNA) and Pharmacy preferences + Verifies the presence of Health Care Proxy (HCP) + Participates in discharge planning activities as requested by the Complex Care Manager such as but not limited to facilitating referrals to our post-acute providers, facsimile of referral packets to our post-acute liaisons, witnessing the completion of a healthcare proxy. + Initiated VNA referrals and contacts VNA agencies to confirm visit upon discharge. + Initiates screening process for rehabilitation facilities in Meditech utilizing our Top 3 Choices process which entails obtaining from our patient and/or their caregiver the top three facilities they would like to be referred to for their post­ acute rehabilitation services. Communicates with facility staff to discuss requests for complex patient discharges. + Reaches out to facilities for screening determinations if no response within 24hrs. + Researches/queries Insurers for network information (VNA Agencies, Durable Medical Equipment (DME) vendors, Rehabilitation facilities), transportation benefit verification. + Obtains DME as requested by Case Managers. + Works collaboratively with Case Manager to coordinate ground transportation. + Ensures Important Message (IM) notices for Medicare patients have been distributed and completes all required IM documentation. + Ensures Medicare Outpatient Observation Notice (MOON)for Medicare patients have been distributed and completes all required MOON documentation. + Ensures Case Managers taxi voucher supply is at the required amount. + Completes referrals as identified by Case Managers (i.e. Pharmacy or taxi vouchers) + Communicates clinical inf01mation provided by Case Managers to payers to comply with utilization review requirements. + Management of centralized ambulance booking for Central Medical Emergency Direction (CMED). + Management of appeals and denials for medical necessity. + Management of daily faxed communication to/from payers via Trace, our cloud-based incoming fax queue. + Initiates payer requests for retrospective reviews. + Management of insurance change notification process in collaboration with the Patient Access Benefit Specialist. + Management of insurance line voice mail. + Data entry of payer contact info. + Faxing payer logs to appropriate contacts. + Faxing/copying of patients' medical record to supporting discharge referrals as needed. + Supports the coordination and faxing of the Medicaid Long Term Care Pre-admission Screening form and Minimum Data Set -Home Care. EDUCATION AND RELATED EXPERIENCE: Required: + High School Diploma, GED or equivalent + Knowledge and understanding of medical terminology + Strong organizational skills + Flexibility and accountability + Demonstrated verbal, written skills + Interpersonal skills required + Critical thinking and knowledge of regulatory standards and reimbursement requirements + Computer skills required Preferred: + Bachelor's Degree Lawrence General Hospital is a private, non-profit community hospital providing the Merrimack Valley & southern New Hampshire regions with patient-centered, compassionate, and quality health care for the whole family. For over 140 years, the dedicated doctors, nurses, and staff of Lawrence General have been committed to improving the health of the people and communities we serve. LGH offers competitive pay, a robust benefit package, generous paid time off and free parking. We are an Equal Opportunity Employer committed to hiring a diverse workforce.