Case Management Assistant-ECM

Loma Linda University Health; Loma Linda (CA); On-site; USD 52,000 - 76,000; Full time

Job summary

The Case Management Assistant (CMA) collaborates with Case Managers and Social Workers to support the continuum of care and discharge planning. Communicates clinical information, referrals and coordination of insurance review.

Collaborates with the PBO to identify payer sources, completes TARs, and supports reimbursement, denials and appeals; coordinates patient placements and care transitions. Associate's degree preferred with at least three years in a medical setting.

Qualifications

• Associate's degree preferred; minimum three years experience in medical groups, managed care, hospital admitting or medical nursing unit required.
• Hospital and/or insurance experience preferred.

Responsibilities

• Collaborate with Case Managers and Social Workers to support continuum of care and discharge planning.
• Communicate clinical information, referrals and insurance coordination.
• Assist PBO in identifying payer sources, eligibility, or indigent programs; prepare TARs for county offices.
• Support on-site reviewer functions, reimbursement, and denial/appeals processes.
• Coordinate patient placements, durable medical equipment, and care transitions.

Skills

English communication

Customer service

Attention to detail

Education

Associate's degree

Job description

This role supports care coordination for the Enhanced Care Management Team

This is a full time, day shift position, Monday - Friday from 8am-4:30pm

Job Summary:

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.

Education and Experience:

Associate's Degree in related field preferred. Minimum three years experience with a medical group, managed care organization, utilization management, hospital admitting, or medical nursing unit required. Hospital and/or insurance experience preferred.

Knowledge and Skills:

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.

Licensures and Certifications:

Medical Assistant Certification preferred.

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