Job Description:
• Reach out to members telephonically to assist with referrals, authorizations, HHC, DME needs, medication refills, make provider appointments and follow ups, etc.
• Create cases, tasks, and complete documentation in the case management module for all hospital and skilled nursing facility (SNF) discharges
• Comply and document tasks assigned by nurse
• Work as a team with the case manager to engage and manage a panel of members
• Manage new alerts and update case manager on changes in condition, admission, discharge, or new diagnosis
• Establish relationships with members, earn their trust and act as patient advocate
• Escalate concerns to nurse if members appear to be non-compliant or there appears to be a change in condition
• Assist with outreach activities to members in all levels of case management programs
• Assist with maintaining and updating members' records
• Assist with mailing or faxing correspondence to members, primary care physicians (PCP), and / or Specialists
• Request and upload medical records from PCP’s, specialists, hospitals, etc.
• Meet specific deadlines (respond to various workloads by assigning task priorities according to department policies, standards, and needs)
• Maintain confidentiality of information between and among health care professionals
Requirements:
• Minimum (1) year experience working in health care such as health plan, medical office, Independent Practice Association (IPA), Management Services Organization
• Minimum (1) year experience assisting members / patients with authorizations, scheduling appointments, identification of resources, etc.
• High School Diploma or GED.
• Bachelor's degree or four years additional experience in lieu of education
• Able to read and interpret documents such as safety rules, operating and maintenance instructions and procedure manuals
• Medical assistant training, medical terminology training
• Problem-Solving Skills: Effective problem solving, organizational and time management skills and able to work in a fast-paced environment. Knowledge of Managed Care Plans Knowledge of Medi-Cal
Benefits:
• Health insurance
• Retirement plans
• Paid time off