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Case Management Assistant

Case Management Assistant

Driscoll Children's HospitalCorpus Christi, TX, US
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Where Compassion Meets Innovation And Technology And Our Employees Are Family

Thank you for your interest in joining our team! Please review the job information below.

General Purpose Of The Job :

This position provides technical support to the Utilization Management and Case and Disease Management Departments to ensure all referrals / authorizations, phone calls, reports are addressed and completed in a timely manner.

Education and / or Experience :

  • Must have a high school diploma or equivalent.
  • 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.

Case Manager Assistant Knowledge, Skills and Responsibilities :

Knowledge :

  • Knowledge of Medicaid managed care and health plan processes preferred.
  • Medical terminology preferred.
  • Prior medical office or hospital experience required.
  • Ability to understand complex situations and interpersonal dynamics so as 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 are not responsible for conducting any UM review or CM / DM 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 Case Management Assistants, Nurse Case Managers, and other departments as appropriate according to the "RightFax Distribution Guide".
  • Process complex authorization requests according to decision-making tool (Authorization Guide) to include forwarding information to nurses 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 categorized Alberto N.
  • Maintain RightFax distribution, authorization, and telephone turn-around-time stats.
  • Answer Automated Call Distribution (ACD) line during mandated hours of operation (8am to 5pm CST).
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    Case Management Assistant • Corpus Christi, TX, US