Join our award-winning team at University of Washington Medical Center (UWMC). Among the top medical centers in the United States, and ranked as the number 1 hospital in Washington State, as rated by U.S. News & World Report 2019-2020 "America's Best Hospitals", UWMC prides itself on compassionate patient care as well as its pioneering medical advances. UWMC is operated by the University of Washington (UW) and serves as a training site for UW’s School of Medicine.
The University of Washington is proud to be one of the nation’s premier educational and research institutions. Our people are the most important asset in our pursuit of achieving excellence in education, research, and community service. Our staff not only enjoys outstanding benefits and professional growth opportunities, but also an environment noted for diversity, community involvement, intellectual excitement, artistic pursuits, and natural beauty. As an employee, you will enjoy generous benefits and work/life programs. For a complete description of our benefits for this position, please click here..
The UWMC Bone & Joint Center has an outstanding opportunity for a Full-time, Day Shifts, WORKERS’COMPENSATION/DISABILITY MANAGEMENT CARE COORDINATOR (PROGRAM COORDINATOR). Responsible to the Clinic Manager, BOS or PCC/PSS Supervisor, and COHE Program Manager, the role is based in a HMC or UW outpatient clinic setting and performs care coordination for workers’ compensation patients including State Fund, Self-Insured, Federal, and Out-of-State employers. May involve inpatient contact when the need arises.
This role includes claim coordination with claims managers, vocational counselors, employers, attorneys, occupational nurse consultants, and nurse case managers to assist clinic faculty or staff with claim coordination, return-to-work coordination, authorization, and billing. Educate external stakeholders about interacting with health care providers/UW Medicine system, via telephone. Act as a consultant and provides technical education/recommendations to front desk staff and back office (RN, MA, etc.) staff regarding workers’ compensation information requests/claim processes.
Patient Population Patient population includes workers’ compensation acute, chronic and catastrophic claims/injuries and/or complex claims, with a mission-based focus (e.g. low income, non-English speaking, uninsured/underinsured, etc.). Educate patients about workers’ compensation system, including answering any questions. Exercise independent and joint judgment in interpreting as well as applying rules and regulations. Utilizes empathy and motivational-based practices, when appropriate.
DISTINGUISHING CHARACTERISTICS: Under general direction, the role performs care coordination work using institutional, departmental, Federal/State/local/out-of-state policies, procedures, knowledge, and experience regarding the care needs of injured worker patients, providers and staff. Handle medical records in accordance with institutional and State of Washington RCW/WACs. Basic and specialized understanding of insurance coverage requirements related to authorization, referrals, third party payer and reimbursement procedures to assist clinic staff.
May seldom to occasionally (based on clinic setting) perform vocational services coordination including discussing with patient about return-to-work status/plan; calling employer about job availability/basic medical information/work restrictions; educating health care provider about L&I informal and formal vocational counseling and structured steps/options.
Patient Access/Insurance: • Screen workers’ compensation claims for correct coverage; work with clinic or hospital staff to correct insurance coverage billing issues, and to increase knowledge/policy understanding of these roles. • Knowledge of guarantor account types and coverages; may update guarantor account type/coverages based on appt., when correction/update is needed. • Access claim file through pertinent Electronic Medical Record systems, or call the workers’ compensation insurer Claims Manager for claim information. Review and/or request internal and external medical records to support heath care providers, clinic staff and/or patient with referral, claim barriers, or authorization. • Referral to internal patient financial resources (e.g. Financial Counseling, Financial Services, Access/Pre-Registration), when appropriate. • Knowledge of advanced imaging authorization processes and procedures. • When appropriate, obtain Claims Manager approval for L&I/Self-Insured Employer treatments (e.g. mental health, pain clinic, work conditioning/hardening, functional capacity evaluation, SIMP, PT/OT). • Coordinate with PCC/PSS for emergent medical tx, when needed.
Patient Coordination/Counseling: • Act as a liaison and perform in-person and telephone care coordination among health care providers, staff, patients in addition to vocational counselors, and employers regarding medical, return-to-work, and insurance benefit information. • Review, coordinate, and process administrative paperwork with and/or without health care provider input. When appropriate, communicate with faculty and staff about Attending, Consulting, Concurrent role in claim. • Address and resolve internal or external stakeholder complaints; may call upon clinic management or COHE Program Manager for assistance. • Compose correspondence to assist with authorization, medical, vocational clarity, etc; review by health care provider. •Brief in-person or telephone interview of patient regarding areas of workers’ compensation concerns and return-to-work status. • Provide information regarding travel reimbursement, etc. • Educate patient re: workers’ compensation rights/responsibilities with and/or without health care provider present. • Provide written workers’ compensation information to patient, when applicable. • Identify patient’s return-to-work goal, to assist health care provider with medical and return-to-work recovery (see above for distinguishing characteristics, and additional duties). • Provide information to patient about finding an Attending Provider, when needed. • Monitor or assist with medical treatment or diagnostic recommendations, when barriers arise. May refer to internal or external resources regarding social, financial or vocational needs. • Address and resolve patient complaints; may call upon clinic management or COHE Program Manager for assistance. • Engage in EMR documentation as well as billing for claim coordination work. Use of variety of EMR systems including Reg/ADT, Epic, ORCA, Mindscape, OneHealthPort, Microsoft Suite. • When requested and applicable, utilize and post EHR case notes into L&I’s Occupational Health Management System. Utilizes Epic Work Queue for case management purposes • Role contributes to occupational health best practices education/training including program interventions which may exist (e.g. work hardening, SIMP, PGAP, FCE, etc) to reduce disability among injured workers, among faculty and staff. Facilitate access to workers’ compensation claim benefits and programs such as Stay at Work, Early Return to Work, vocational counseling, and other processes through communication with employer, patient, and other stakeholders. • Participate in multidisciplinary staffing meetings or huddles; interact with health care providers regarding services to address complex or claims with psychosocial related barriers. Connect and/or train health care provider/staff regarding hospital or external workers’ compensation resources to address concerns (e.g. may refer patient to outpatient Social Work, when needed). •Participate in identification of continuous improvements and solutions, including guiding clinic management regarding the creation of policies/procedures or workflows in complement to payor regulations. •Other duties, including coverage, as needed e.g. Referral Coordination, PCC
Administrative: • Attend and participate in clinic and workers’ compensation staff meetings, or obtain supervisor coverage/meeting attendance; discuss patient claim or institutional related claim issues. • Ensure scanning of medical records into patient record and/or send administrative records to HIM for scanning. • Manage and respond to Epic in-basket, personal email, voicemail, faxes.
DESIRED QUALIFICATIONS: Bachelor’s Degree or Associates Degree, and three years’ of experience in direct patient care, return-to-work coordination, occupational health care, or equivalent experience. Experience or demonstrated skills in oral and written communication with health care professionals and patients. May have vocational counselor, occupational therapist, physical therapist, social worker, occupational or case manager experience.
CORE VALUES: • Respect privacy and confidentiality • Communicate effectively (verbal and written) • Professional conduct/Integrity • Accountability • Commitment/Service
Founded in 1861, the University of Washington is one of the oldest public institutions in the west coast and one of the preeminent research universities in the world. The University of Washington is a multi-campus university comprised of three different campuses: Seattle, Tacoma, and Bothell. The Seattle campus is made up of sixteen schools and colleges that serve students ranging from an undergraduate level to a doctoral level. The university is home to world-class libraries, arts, music, drama, and sports, as well as the highest quality medical care in Washington State and a world-class academic medical center. The teaching and research of the University’s many professional schools provide undergraduate and graduate students the education necessary toward achieving an excellence that will serve the state, the region, and the nation. As part of a large and diverse community, the University of Washington serves more students than any other institution in the Northwest.