Case Management Assistant- TCS ECM- Bakersfield 1.1

Universal Healthcare MSO LLC•Bakersfield, CA

16h•$21 - $27•Onsite

About The Position

The Case Management Assistant- Transitional Care Services (TCS) provides support for the Case Management Department, including the Nurse Case Managers and Social Services team specifically through the coordination of services within the Enhanced Care Management (ECM) Program specific to transitional care services. The Case Management Assistant will provide support by assisting in managing members who are undergoing transitions from various care settings, including ER visits, acute care admissions, post-acute care admissions, incarcerations, and other ECM-recognized transitional care settings. The Case Management Assistant TCS will assist in enhanced care coordination activities, monitor members, report findings, and gather clinical information from outside sources. The ECM Program addresses the clinical and nonclinical needs of members with the most complex medical and social needs through systematic coordination of services and comprehensive care management. ECM is intended to service those with chronic health conditions, are homeless or at-risk, with high hospital admissions, substance abuse, and/or behavioral health needs. This position requires strong interpersonal and organizational skills to build rapport with members, coordinate referrals, and care amongst various healthcare providers and community services. The Case Management Assistant TCS also collaborates with the member’s inter-disciplinary team (ICT) supporting the member, while engaging the member and their support systems to define priorities that are central to the member’s desired needs and goals.

Requirements

High School diploma or GED required.
Minimum of 3 years of experience working in a health care or community health setting.
Advanced knowledge of prior authorization or case management regulations governing Medi-Cal, Commercial, Medicare, CCS, and other government and commercial programs.
Possession of valid driver’s license
Proof of state-required auto liability insurance.

Nice To Haves

Experience in a managed health care environment preferred (IPA, HMO, or Health Plan).
Medical Assistant or Community Health Worker certification preferred.

Responsibilities

Works collaboratively and assists the Clinical or Social Services Case Manager to manage members in need of Transitional Care Services.
Gather clinical information and assists with coordinating post-discharge services, including scheduling provider appointments, ensuring post-discharge referrals are received by the member, transportation to appointments is arranged, and members are aware of follow-care needs.
Proactively initiates care transition coordination with referral sources and internal partners to ensure seamless patient transitions to home or ATS. Participates with any data collection required for therapy start and patient tracking process. This may include facilitating the transfer of orders via phone, fax, and e-prescribing.
Effectively manage low acuity member cases within the ECM Program.
Contacts members at regular intervals per their acuity level and care plan needs.
Completes member questionnaires or assessments and consistently document care management activities and encounters in the CM System, per program protocol.
Works collaboratively and assists clinical and social services Case Managers with care coordination, member follow-up, communication with appropriate agencies and preparation and distribution of documents and/or reports.
Reports variances and issues to nursing or social services staff assigned to the member.
Assists members with appointment scheduling, transportation, referral coordination, and other enhanced care coordination services.
Gathers clinical information from outside sources such as PCPs, specialists and other providers, electronic health records, and other partnering entities.
Verifies member eligibility, demographic information, and benefits.
Verifies member's Primary Care Physician and the Physician Specialist to ensure that authorization is requested and issued to appropriate network provider.
Assists in maintaining the integrity of the data systems by entering information into department’s data systems.
Provides general office administration duties including answering phones. Provides general customer service to all potential and exiting ECM members and partnering agencies.
Gathers relevant information for the identified member population during assessment, care planning, interdisciplinary care team meetings, and transitions of care.
Outreaches to members to verify that needs are being met and services are being delivered.
Intervenes at the member level to coordinate the delivery of direct services to the member and their families.
Serves as an associate and resource to members, providers, staff, and external customers regarding policies, benefits, and care coordination.
Assists with system letters, requests for information and data entry.
Gather information, present, and participate in Interdisciplinary Care Team (ICT) meetings, and communicate the member’s needs and preferences in a timely manner to the member’s multi-disciplinary care team.
Attend mandatory departmental and staff meetings.
Assist with training and orientation of new staff.
May be assigned to conduct in-person meetings with members during clinic visits.
Performs other duties as assigned.