Care Management Assistant

About the position

This position provides clerical and administrative support to enhance integrated care management for targeted populations and individuals. Facilitates communication with payers and authorization of services in accordance with regulatory and contractual requirements, patient and family-centered interdisciplinary care planning, effective care coordination, collaboration and communication between healthcare settings, and effective transitions to the appropriate level of care.

Responsibilities

• Serves as the primary contact with payers, receiving and prioritizing requests and sending clinical information for authorization of services based on contractual requirements.
• Promptly communicates utilization review needs, days authorized, denials, and other communication from the payers to care managers and physician advisors.
• Collaborates with the revenue cycle staff and others to research payment sources.
• Maintains a current list of contractual requirements and contact information by payer.
• Promptly distributes new information and communicates changes to care management staff and leaders.
• Requests and retrieves medical records from the Health Information Management for retrospective utilization or quality assurance review.
• Delivers routine regulatory notices to patients in the required timeframe.
• Performs a variety of specific clerical tasks to support care management services.
• Supports advanced care planning by delivering advance directive information and notarizes documents upon request.
• Supports a compliant patient choice process by ensuring online provider lists are current in all systems.
• Provides support for transition planning.
• Consistently documents all communication, actions, and information.
• Promptly reports issues and concerns to the departmental chain-of-command.
• Assists with special programs including data collection for process improvement projects.

Requirements

• Two years of healthcare experience.
• Advanced computer skills including developing spreadsheets, creating charts and graphs, word processing, process flows, complex formatting, data manipulation, creating and running reports, creating presentations, and using multimedia content.
• Two years of experience working in an office setting, working in a clerical position with keyboarding and data entry responsibilities, or working in customer service.
• Experience coordinating projects.
• Demonstrated interpersonal verbal and written communication skills including being proficient in spelling, punctuation, grammar, and other English language skills.
• Demonstrated basic math skills.

Nice-to-haves

• Spanish speaking preferred.
• Medical Assistant background.
• Licensure: LPN; Associate Degree RN; BSW.
• College courses related to healthcare, business, and/or computer/information systems.
• 2 years of experience working in a clinical healthcare setting.
• Medical terminology experience.
• Medical transcription experience.
• Leadership experience.

Benefits

• Generous benefits package covering a wide range of programs to foster a sustainable culture of wellness.
• Tuition coverage paid directly to the academic institution through the PEAK program.