Medical Case Management Assistant - Referrals

This is a remote position. 

The preferred hours for this position is 9 am - 5:30 pm Pacific time or 12 pm - 8:30 pm Eastern time.

POSITION SUMMARY:

Work directly with the Supervisor and Manager to provide additional resources for the case management staff. This position does not provide any clinical review or decisions.

This individual is responsible for monitoring incoming correspondence received.  The coordinator will ensure the referrals are set up in the case management system and promptly assigned to the case manager. The Referral Coordinator will answer incoming calls, screen, respond and route the calls. This position requires the ability to work independently to meet deadlines, as well as an excellent phone demeanor and a desire to provide exceptional customer service. The position requires knowledge of medical terminology, the understanding of referral criteria by client and/or jurisdictions. The referrals may be for WC Utilization Review and or Case Management services.

Responsibilities of the position include, but are not limited to:

• Set up of member within the case management system
• Assist incoming calls to the case management referral department
• Monitor dedicated referral emails to review for new referrals and correspondence

• Monitor workflow of referrals and identify areas where daily assistance is needed
• Work with the branch locations and staff to complete and provide necessary information for referrals 
• Process all referrals and correspondence within 24 hours of receipt
• Maintain daily/monthly referral logs
• Identify trends and/or issues in referral patterns and communicate them with management.

***Other duties as assigned

Additional Functions and Responsibilities

• Demonstrates ability to meet administrative requirements, including productivity, time management and Quality Assurance standards
• Maintain documentation standards adhering to URAC standards and company policy and procedures
• Maintain confidentiality- Knowledge of laws and regulations pertaining to HIPPA and PHI
• Other job duties as assigned

Equipment Operated/Used:

Essential Equipment: Desk, Telephone/Fax, Computer Keyboard, Mouse, System Applications

Essential Tools: Pens, pencil, computer, Keyboard

Essential Vehicles:  N/A 

Special Equipment or Clothing:

Professional attire adhering to the Company Dress Code