Case Management Assistant

Loma Linda • Loma Linda, CA

8h

About The Position

The Case Management Assistant (CMA) collaborates with Case Managers
and Social Workers in assisting with the continuum of care and discharge
planning. Communicates clinical information, referrals and coordination of
insurance review. Collaborates with the PBO (Patient Business Office) for
identification of payer sources, eligibility, or indigent programs; completes
TAR's (Treatment Authorization Requests) for submission to the county field
offices for medical authorization, supports medical on-site reviewer functions, assists with reimbursement, authorization contracts, and supports the denials
and appeals process. Functions under the direction of a Case Manager with
minimal supervision, takes responsibility for professional growth, and assists
in the coordination of patient placements, ordering of durable medical equipment
and coordinating care transitions. Performs other duties as needed.

Requirements

• Minimum three years experience with a medical group, managed care organization, utilization management, hospital admitting, or medical nursing unit required.
• Acquires and maintains working knowledge of Medi-Cal, CCS, CMS and commercial regulations and managed care
• Knowledge of state managed health plans and contracting.
• Able to read; write legibly; speak in English with professional quality; use computer and software programs necessary to the position
• Operate/troubleshoot basic office equipment required for the position.
• Able to relate and communicate positively, effectively, and professionally with others; able to demonstrate positive customer service skills; work calmly and respond courteously when under pressure; lead, supervise, teach, and collaborate; accept direction.
• Able to communicate effectively in English in person, in writing, and on the telephone; think critically; work independently with minimal supervision; perform basic math functions; manage multiple assignments effectively; work well under pressure; problem solve; organize and prioritize workload; recall information with accuracy; pay close attention to detail; maintain confidential records and correspondence.
• Able to distinguish colors as necessary; hear sufficiently for general conversation in person and on the telephone; identify and distinguish various sounds associated with the work place; see adequately to read computer screens, medical records, and written documents necessary to position.

Nice To Haves

• Associate's Degree in related field preferred.
• Hospital and/or insurance experience preferred.
• Medical Assistant Certification preferred.

Responsibilities

• Collaborates with Case Managers and Social Workers in assisting with the continuum of care and discharge planning.
• Communicates clinical information, referrals and coordination of insurance review.
• Collaborates with the PBO (Patient Business Office) for identification of payer sources, eligibility, or indigent programs
• Completes TAR's (Treatment Authorization Requests) for submission to the county field offices for medical authorization
• Supports medical on-site reviewer functions, assists with reimbursement, authorization contracts, and supports the denials and appeals process.
• Assists in the coordination of patient placements, ordering of durable medical equipment and coordinating care transitions.
• Performs other duties as needed.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: Associate degree