Case Management Assistant

Where compassion meets innovation and technology and our employees are family.

GENERAL PURPOSE OF JOB:

This position provides technical support to the Utilization Management (UM) Department to ensure all referrals/authorizations, phones calls, reports are addressed and completed in a timely manner.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. This job description is not intended to be all-inclusive; employees will perform other reasonably related business duties as assigned by the Director, Utilization Management as required.

Knowledge, Skills, and Responsibilities:

Knowledge:

• Knowledge of Medicaid managed care and health plan processes preferred.
• Medical terminology preferred.
• Prior medical office, hospital experience, or MCO experience required.
• Ability to understand complex situations and interpersonal dynamics to effectively handle escalated customer and co-worker needs.

Skills:

• Requires a well-organized individual with an excellent capacity for effective time management.
• Demonstrates ability to establish and maintain effective working relationships with the provider office staff and peers.
• Demonstrates ability to operate personal computer programs as well as complex medical management software.
• Basic Microsoft Office skills.
• Excellent communication skills.

Responsibilities:

• Case Manager Assistants (CMAs) are not responsible for conducting any UM review activities that require interpretation of clinical information including non-certification of requests. Licensed health professionals are available for oversight.
• Review authorization requests for completeness of information.
• Review faxed authorization request types to determine appropriate distribution.
• Data enter authorization templates, attach faxed clinical received and forward the information via a system task to CMAs, Case Managers, and other departments as appropriate according to the “Right Fax Distribution Guide”.
• Process complex authorization requests according to decision-making tool (Authorization Guide) to include forwarding information to Case Managers and medical director as appropriate.
• Ability to work independently and as part of a team.
• Collection and transfer of non-clinical data and input of various types of information into the complex Medical Management System.
• Assist in collection of structured clinical data and input of various types of information into the complex Medical Management System.
• Understand how to process or distribute authorizations, which are lacking information for CHIP and STAR members.
• Maintain Right Fax distribution, authorization, and telephone turn-around-time stats.
• Answer Automated Call Distribution (ACD) line during mandated hours of operation (8 am to 5 pm CST).

EDUCATION AND/OR EXPERIENCE:

• Must have a high school diploma or equivalent; college education preferred.
• Two (2) years prior experience in a managed care organization or medical setting preferred.
• Medical Terminology preferred.
• Prior medical office or hospital experience preferred.
• Basic Microsoft Office skills required.