Clinical Review Team Navigator/PCMA (days full time) One Ford Place - Saint Clair Shores, Michigan - 18 hours ago - 1711355 Apply for Job - GENERAL SUMMARY: - Reports to the Director of Patient Care Management and Assistance (PCMA). - Under minimal supervision, this position is responsible for assisting the Clinical Review Team screen uninsured and underinsured patient care requests for medically necessity and urgency and ensuring that all financial responsibilities are addressed before services are rendered. - Advises patients of available financial assistance programs and collaborates with physicians and HFHHN staff to determine continuing care needs. PRINCIPLE DUTIES AND RESPONSIBILITIES:

• Identifies patients with inadequate access to resources; including health insurance coverage, primary care services and medications, and provides referrals to affordable community based resources as appropriate. - Manages EPIC work queues to ensure that all financial responsibilities are addressed before services are scheduled and/or rendered. Obtain insurance referrals and authorizations when needed and provides feedback to schedulers when underinsured patients are scheduled incorrectly. - Conducts the initial review of care requests of uninsured and underinsured patients for financial assistance based on approved criteria. Prepares complex patient care requests for 2nd and 3rd level reviews by the Clinical Review Team for medical necessity and urgency. - Appropriately registers and schedules approved patients based on the Clinical Review Teams determination. - Handles all in-coming telephone activity, including answering phones promptly, according to clinic protocol; opens and closes conversation appropriately; manages call volume, according to system standards; records messages thoroughly, accurately, and legibly; initials messages. - Identifies actual and potential problems within the HFHS financial assistance programs to improve the patient care process and utilization of outpatient resources through the appropriate action and/or recommendation. - Maintains strict confidentially standards for patient information. Complies with organizational, federal, and state regulations and policies on confidentiality. - Performs other related duties as required. EDUCATION/EXPERIENCE REQUIRED - High School Diploma/G.E.D. with at least 1-2 years previous experience working as a patient navigator, patient advocate, financial navigator or insurance verification specialist required; - Knowledge of at least two software packages (I.e. word processing, spreadsheet, or graphics) is required. - Proficiency in EPIC applications such as Appointment Scheduling (all versions), Registrations, Work Queues and Referrals, is required. - Associate's Degree or 2 years of college in business, community health, social work, case management or a related field, preferred.Minimum of 2-5 years of experience, preferred. Knowledge of medical terminology, preferred. - Bilingual, as appropriate to the work site. - Possess the ability to speak clearly and effectively. - Customer service-oriented including the ability to interact professionally and handle sensitive information/issues in a confidential, respectful, assertive, and empathetic manner in difficult interpersonal situations. Acts in a manner that establishes positive rapport with patients, families, and public/private financial assistance programs. - Ability to quickly assess and respond appropriately to emergency situations. Ability to comprehend medical terms. Analytical skills to resolve complex problems requiring the use of scientific, mathematical, or technical principles, and in-depth experience in multi-tasking. Ability to deliver consistent results and possess the drive to continually improve processes to benefit the patient and the hospital system. - Ability to visually proofread typed work for errors. Ability to communicate via telephone to a variety of groups (patients, patients families, insurance companies, other departments, etc.) Other Preferred Requirements: - Ability to analyze and interpret information included in but not limited to HFHS support application materials, IRS materials, credit reports, payer regulations, payer contracts etc. - Analytic skills to assess data and formulate appropriate and prompt sequence of steps to resolve patient questions or concerns. - Knowledge of managed care and referral/pre-certification procedures. - Understanding and working familiarity with rules and regulations of Federal, State and County programs and payer requirements. - Overview Henry Ford Health System, one of the largest and most comprehensive integrated U.S. health care systems, is a national leader in clinical care, research and education. The system includes the 1,200-member Henry Ford Medical Group, five hospitals, Health Alliance Plan (a health insurance and wellness company), Henry Ford Physician Network, a 150-site ambulatory network and many other health-related entities throughout southeast Michigan, providing a full continuum of care. In 2015, Henry Ford provided $299 million in uncompensated care. The health system also is a major economic driver in Michigan and employs more than 24,600 employees. Henry Ford is a 2011Malcolm Baldrige National Quality Award recipient. The health system is led by President and CEO Wright Lassiter III. To learn more, visit - . - Benefits Whether it's offering a new medical option, helping you make healthier lifestyle choices or making the employee enrollment selection experience easier, it's all about choice. Henry Ford Health System has a new approach for its employee benefits program - My Choice Rewards. My Choice Rewards is a program as diverse as the people it serves. There are dozens of options for all of our employees including compensation, benefits, work/life balance and learning - options that enhance your career and add value to your personal life. As an employee you are provided access to Retirement Programs, an Employee Assistance Program (Henry Ford Enhanced), Tuition Reimbursement, Paid Time Off, Employee Health and Wellness and access to day care services at Bright Horizons Midtown Detroit, and a whole host of other benefits and services. - Equal Employment Opportunity/Affirmative Action Employer Equal Employment Opportunity / Affirmative Action Employer Henry Ford Health System is committed to the hiring, advancement and fair treatment of all individuals without regard to race, color, creed, religion, age, sex, national origin, disability, veteran status, size, height, weight, marital status, family status, gender identity, sexual orientation, and genetic information, or any other protected status in accordance with applicable federal and state laws. - Create and manage profiles for future opportunities. - Track your opportunities. - ? 2018 Henry Ford Health System. All rights reserved.