Care Management Assistant

Essential Functions

• Serves as a liaison between the department and external organizations or individuals, including payers, physicians, post-acute agencies, patients, patient, patient representatives, and other departmental stakeholders.
• Receives and prioritizes requests and transmits clinical information for service authorizations in accordance with contractual requirements and communicates with care managers, utilization review RNs, revenue cycle, and payers as needed to coordinate processes and research payment sources.
• Maintains ongoing communication regarding the status of referrals and educates patients about available resources.
• Requests and retrieves medical records from Health Information Management for retrospective utilization review or quality assurance.
• Delivers routine regulatory notices to patients within the required timeframes, ensuring proper documentation to support the delivery of government-mandated forms or payer communication.
• Performs clerical tasks to support care management services, including preparing and printing reports, scheduling appointments, distributing and communicating requests, retrieving message (phone, fax, email, and mail), and scanning or copying documents as needed.
• Supports advanced care planning by delivering advance directive information and notarizing documents upon request.
• Aids in transition planning by preparing transfer packets, arranging transportation, updating resources on the Integrated Care Management website, and coordinating with patients, families, and next-level providers.
• Collaborates with care managers to navigate and refer patients to community resources that address social determinants of health.
• Works closely with care managers and clinical teams to ensure patients receive comprehensive and coordinated care.
• Contributes, in collaboration with Care Management, to the monitoring and success of patient care plans and the resolution of identified social needs.

Minimum Qualifications

• Demonstrated healthcare experience in a clinic or hospital setting.
• Demonstrated customer service with a focus on communications and problem resolution.
• Proficiency in advanced computer skills.
• Caregivers whose duties require them to conduct home or community visits must maintain current BLS certification, have a current driver’s license, current auto insurance, an acceptable driving record and reliable transportation.
• Demonstrated knowledge of medical terminology is preferred.
• Excellent verbal and written communications skills.

Physical Requirements

• Ongoing need for employee to see and read information, labels, documents, monitors, identify equipment and supplies, and be able to assess customer needs.
• Frequent interactions with providers, colleagues, customers, patients/clients, and visitors that require employee to verbally communicate as well as hear and understand spoken information, needs, and issues quickly and accurately.
• Manual dexterity of hands and fingers to manipulate complex and delicate supplies and equipment with precision and accuracy. Includes frequent computer use for typing, accessing needed information, etc.
• Mental stamina and flexibility - ability to handle high stress situations, make quick decisions, and manage multiple tasks simultaneously.
• For roles requiring driving: Expected to drive a vehicle which requires sitting, seeing, and reading signs, traffic signals, and other vehicles.