Thank you for your interest in joining our team! Please review the job information below.
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.
Case Manager Assistant 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.
Skills Required
- High school diploma or equivalent; college education preferred
- Two years prior experience in a managed care organization or medical setting preferred
- Knowledge of Medicaid managed care and health plan processes
- Prior medical office, hospital experience, or MCO experience
- Basic Microsoft Office skills
What We Do
We provide the absolute best pediatric care in South Texas, where care and community come together. Together, we heal
