Case Management Assistant
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
- Working knowledge of Medi-Cal, CCS, CMS and commercial regulations and managed care
- Knowledge of state managed health plans and contracting
- Able to read
- Able to write legibly
- Able to speak in English with professional quality
- Able to use computer and software programs necessary to the position
- Able to 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
- Able to work calmly and respond courteously when under pressure
- Able to lead, supervise, teach, and collaborate
- Able to accept direction
- Able to communicate effectively in English in person, in writing, and on the telephone
- Able to think critically
- Able to work independently with minimal supervision
- Able to perform basic math functions
- Able to manage multiple assignments effectively
- Able to work well under pressure
- Able to problem solve
- Able to organize and prioritize workload
- Able to recall information with accuracy
- Able to pay close attention to detail
- Able to maintain confidential records and correspondence
- Able to distinguish colors as necessary
- Able to hear sufficiently for general conversation in person and on the telephone
- Able to identify and distinguish various sounds associated with the work place
- Able to 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
- Assisting with the continuum of care and discharge planning
- Communicating clinical information, referrals and coordination of insurance review
- Collaborating with the PBO (Patient Business Office) for identification of payer sources, eligibility, or indigent programs
- Completing TAR's (Treatment Authorization Requests) for submission to the county field offices for medical authorization
- Supporting medical on-site reviewer functions
- Assisting with reimbursement, authorization contracts
- Supporting the denials and appeals process
- Taking responsibility for professional growth
- Assisting in the coordination of patient placements
- Ordering of durable medical equipment
- Coordinating care transitions
- Performing other duties as needed
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
Associate degree
