Asst. Case Mgmt. , El Paso Health

El Paso Health • El Paso, TX

2d

About The Position

Provides technical support to the Case Management (CM) Department by ensuring that all referrals/authorizations, phones calls, reports are addressed and completed in a timely manner. Assists with gathering information for the health care team regarding barriers or other health information. Implements the interventions to promote improved health and compliance with recommended plan of care, as approved by the Health Care Team. Position requires being cross-trained between all UR specialist teams. May serve as a key resource in supporting the case management processes, coordinating linkage between members, primary care providers, specialty providers and other insurance companies. Includes supporting the referral process from providers, as well as pre-authorization approvals and other services as ordered/requested by providers.

Requirements

• Ability to understand complex situations and interpersonal dynamics to effectively handle escalated customer and co-worker needs.
• Well-organized and with excellent capacity for excellent and effective time management skills.
• Ability to work independently and as part of a team.
• Ability to establish and maintain effective working relationships with the provider office staff and peers.
• Ability to operate personal computer programs as well as complex medical management software.
• Excellent communication skills.
• Ability to read and interpret documents Standard Operating Procedures and procedure manuals.
• Ability to write routine reports and correspondence.
• Ability to speak effectively before groups of Members and/or Associates of the organization.
• Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals.
• Ability to compute rate, ratio, and percent and to draw and interpret bar graphs.
• Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form.
• Ability to deal with problems involving several concrete variables in standardized situations.
• Three years of experience in a managed care or medical office setting required.
• Basic Microsoft Office skills required.
• High school diploma or equivalent.

Nice To Haves

• Bilingual (English/ Spanish) highly preferred.
• Prior medical office or hospital experience preferred.
• Knowledge of Medicaid managed care and health plan processes preferred.
• Knowledge of medical terminology preferred.
• Associate degree preferred.

Responsibilities

• Ensuring that all referrals/authorizations, phones calls, reports are addressed and completed in a timely manner.
• Assisting with gathering information for the health care team regarding barriers or other health information.
• Implementing interventions to promote improved health and compliance with recommended plan of care, as approved by the Health Care Team.
• Being cross-trained between all UR specialist teams.
• Serving as a key resource in supporting the case management processes.
• Coordinating linkage between members, primary care providers, specialty providers and other insurance companies.
• Supporting the referral process from providers.
• Supporting pre-authorization approvals and other services as ordered/requested by providers.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED