Case Management Assistant-Utilization Review

Loma Linda University Health; Loma Linda (CA); Hybrid; USD 42,000 - 62,000; Full time

Job summary

Loma Linda University Health is searching for a Case Management Assistant to support care transitions and discharge planning. The CMA works with Case Managers and Social Workers to coordinate referrals, insurance review, TAR submissions, and reimbursement support.

The role requires an Associate's Degree (preferred) with several years in medical settings; strong communication, organization, and attention to detail are essential for managing multiple patient cases in a hybrid (in-office 2

Qualifications

• Associate's Degree preferred; three years of related medical group or managed care experience required.
• Experience in hospital admitting, utilization management or medical nursing unit preferred.
• Knowledge of payer sources, insurance review processes, and durable medical equipment coordination.

Responsibilities

• Assist Case Managers and Social Workers with care transitions and discharge planning.
• Communicate clinical information, referrals and insurance coordination.
• Assist with TAR submissions and authorizations; support reviewer functions and denials/appeals.
• Coordinate patient placements and ordering of durable medical equipment.

Skills

Medi-Cal knowledge

CMS knowledge

English communication

Customer service

Documentation accuracy

Team collaboration

Education

Associate's Degree

Job description

Schedule: Monday-Friday (8am-5pm)

This role is hybrid and requires 2-days in office per week.

Working weekends and holidays are required and based on operational needs.

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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