Medical Case Manager Assistant / WC Scheduler

This is a remote position.  Preference is remote in Texas.

**Preferred experience:  medical assistant; case management experience necessary; medical claims assistant.

**Bilingual English/Spanish preferred.

POSITION SUMMARY:

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

This individual is responsible to ensure the referrals are set up in the Utilization Review/Case Management system and promptly assign to the case manager. The Case Management Assistant 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.

ESSENTIAL DUTIES AND RESPONSIBILITIES RESPONSIBILITES:

• Responds to phone inquiries from providers, patients, case managers, peer

reviewers and directs to the appropriate handling party

• Make initial contact for case management staff
• Initial contact with providers to obtain clinical information

• Assist with case management work flow and documentation prepares routine correspondence for Case Managers, physicians, and patients
• Identify each caller/patient’s needs and determine the next appropriate action, which may include clinic referral or identifying the necessity for the escalation process to be activated.
• Communicates effectively with all parties, such as case managers, physicians, claims team, and ancillary providers and/or vendors/agencies to ensure that patient information is current, accurate, and complete
• Prints and mails correspondence to all necessary parties in accordance with state

rules and regulations

• Other duties as necessary assigned by supervisor

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

• Assist incoming calls to the case management department
• Monitor dedicated queues/emails

• Process all determinations and correspondence within 24 hours of receipt
• Actively participate as a member of the team, working collaboratively with and supporting other staff.
• Complete the assigned deliverable/billable hours per week, as assigned by your Supervisor.
• 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