Medical Case Manager Assistant / WC Scheduler

Tristar Insurance; South Carolina; Hybrid; USD 24,796 - 30,307; Full time

Job summary

Tristar Insurance is seeking a Case Management Assistant to support case management staff by handling referral setup, answering calls, screening inquiries, and routing communications within the Utilization Review/Case Management system. The role requires independent work, a strong phone demeanor, and excellent customer service in a non‑clinical environment.

The position is full-time with a day shift, remote work, and hourly compensation in the $18.00–$22.00 range.

Qualifications

• High school diploma or GED required; medical or managed-care background preferred.
• One year of experience in a medical or managed-care environment preferred.
• Knowledge of medical terminology and referral criteria is preferred.
• Bilingual English/Spanish is preferred.
• Strong communication and customer-service mindset; team oriented.
• Proficient typing 35–40 wpm; good computer skills.

Responsibilities

• Respond to phone inquiries from providers, patients, case managers, and peer reviewers; route calls appropriately.
• Make initial contact for case management staff and obtain required clinical information from providers.
• Assist with case management workflow and documentation – prepare routine correspondence for case managers, physicians, and patients.
• Identify caller needs and determine next action, including clinic referral or escalation process activation.
• Communicate effectively with case managers, physicians, claims team, and ancillary vendors to ensure accurate, complete patient information.
• Print and mail correspondence according to state rules and regulations.
• Process determinations and correspondence within 24 hours of receipt.
• Monitor dedicated call queues and emails, complete assigned deliverables and billable hours.
• Identify referral trends and communicate findings with management.
• Perform other duties as assigned by the supervisor.

Skills

Communication

Customer service

Bilingual EN/ES

Typing 35–40 wpm

Medical terminology

Education

High School Diploma or GED

Tools

Windows

Outlook

Word

Excel

Job description

Job Title: Case Management Assistant (Involuntary Remote)

Location: Remote. Preference for Texas. Job Level: Entry. Full‑Time. Work Hours: Day shift. Salary: $18.00–$22.00 per hour. No travel required.

Position Summary

The Case Management Assistant supports case management staff by managing referral setup, answering incoming calls, screening inquiries, and routing communications within the Utilization Review/Case Management system. The role requires independent work, excellent phone demeanor, and strong customer service in a non‑clinical environment.

Responsibilities

• Respond to phone inquiries from providers, patients, case managers, and peer reviewers; route calls appropriately.
• Make initial contact for case management staff and obtain required clinical information from providers.
• Assist with case management workflow and documentation – prepare routine correspondence for case managers, physicians, and patients.
• Identify caller needs and determine next action, including clinic referral or escalation process activation.
• Communicate effectively with case managers, physicians, claims team, and ancillary vendors to ensure accurate, complete patient information.
• Print and mail correspondence according to state rules and regulations.
• Process determinations and correspondence within 24 hours of receipt.
• Monitor dedicated call queues and emails, complete assigned deliverables and billable hours.
• Identify referral trends and communicate findings with management.
• Perform other duties as assigned by the supervisor.

Qualifications

• High school diploma or GED required; medical or managed‑care background preferred.
• One year of experience in a medical or managed‑care environment preferred.
• Knowledge of medical terminology and referral criteria preferred.
• Bilingual English/Spanish preferred.
• Strong communication and customer‑service mindset; team player.
• Proficient typing (35–40 wpm) and computer skills – Windows, Outlook, Word, Excel.
• Ability to navigate a paperless environment and maintain documentation standards.
• Adherence to professional standards, ethics, policies, and quality‑improvement principles.

Equipment and Tools

• Desk, telephone/fax, computer (keyboard, mouse, system applications).
• Essential tools: pens, pencils, keyboard.
• Professional attire per company dress code.