Care Manager Assistant

PruittHealth; Norcross (GA); On-site; USD 42,000 - 56,000; Full time

Job summary

PruittHealth is seeking a Care Manager Assistant to support facilities in the post-acute setting, coordinating communication and authorization of medically necessary services under supervision from the Care Management leadership.

The role involves handling administrative duties, maintaining compliance with CMS and insurer guidelines, and escalating cases as needed while leveraging strong communication and organizational skills.

Qualifications

• Must understand CMS and Commercial Insurance requirements to ensure compliance with regulations and standards.
• Must have basic knowledge of medical necessity review guidelines for commercial, Medicare, and Medicaid insurance products.
• Demonstrates the ability to communicate effectively via phone and email with internal and external customers.
• Strong organization and ability to multitask is essential to success in this role.
• Identifies and escalates issues that affect the managed care process from a compliance and/or reimbursement standpoint.
• Escalates all cases that require the assistance/approval of a Department Manager, RN Case Manager or LPN Care Manager, for example single case agreements.
• Must be proficient in the use of computer applications for daily use.
• Must be a self-starter and be able to work independently.
• Highly proficient in Microsoft Word, Intermediate Excel and Outlook required.

Responsibilities

• Provide support to assigned facilities to ensure communication and authorization of medically necessary services in the post-acute setting with oversight and support from Department Manager, RN Case Manager and LPN Care Manager.
• Provide administrative and clerical support to the Care Management Department.

Skills

CMS knowledge

Communication skills

Organization

Multitasking

Compliance awareness

Problem escalation

Education

High School Diploma

Tools

Microsoft Word

Microsoft Excel

Outlook

Job description

Job Description - Care Manager Assistant (2613429)

Care Manager Assistant - 2613429

Description

JOB PURPOSE:

The Care Manager Assistant will provide support to assigned facilities to ensure communication and authorization of medically necessary services provided in the post-acute setting with oversight from Department Manager, RN Case Manager or LPN Care Manager. In addition, may be asked to provide a wide range of administrative and clerical support to the Care Management Department.

KEY RESPONSIBILITIES:

The Care Management Assistant will provide support to assigned facilities to ensure communication and authorization of medically necessary services provided in the post-acute setting with oversight and support from Department Manager, RN Case Manager and LPN Care Manager.

KNOWLEDGE, SKILLS, ABILITIES:

• Reasonable demonstration of the ability to understand CMS and Commercial Insurance requirements to ensure compliance with regulations and standards.
• Must have basic knowledgeable of medical necessity review guidelines for commercial, Medicare, and Medicaid insurance products.
• Demonstrates the ability to communicate effectively via phone and email with our internal and external customers.
• Strong organization and ability to multitask is essential to success in this role.
• Identifies and escalates issues that affect the managed care process from a compliance and/or reimbursement standpoint.
• Escalates all cases that requires the assistance/approval of a Department Manager, RN Case Manager or LPN Care Manager, for example single case agreements.
• Must be proficient in the use of computer applications for daily use
• Must be a self-starter and be able to work independently
• Highly proficient in Microsoft Word, Intermediate Excel and Outlook required

Qualifications

MINIMUM EDUCATION REQUIRED:

High School Diploma

MINIMUM EXPERIENCE REQUIRED:

2 years work experience

ADDITIONAL QUALIFICAITONS (Qualifications Preferred):

• Post-acute and/or healthcare industry experience is preferred

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As an Equal Employment Opportunity employer, all qualified applicants will receive consideration without regard to race, color, religion, sex, national origin, disability, or veteran status.