Case Manager, Banning and San Bernardino

Under the direction of the Physicians, the Case Manager has primary responsibility for connecting patients with referral resources to specialty care groups, managed care, health education programs, and community education programs. The Case Manager is also responsible for coordinating transportation for patients, and assisting them in connecting with other services.

RESPONSIBILITIES AND DUTIES

· Data entry via eClinicalWorks software

· Assist medical team in connecting patients with referral resources such as specialty and managed care services.

· Coordinate the referral process

o Work with insurances for eligibility determination

o Referral submissions through electronic clinical system

o Process request that are approved, denied or deferred and in accordance with utilization management policy and procedure

o Communicate effectively and interact with the utilization review nurse and health plans daily or as indicated regarding UM and referral authorization issues.

o Work with patients to schedule specialist appointments and follow ups

o Maintain regulatory turnaround time standards per CMS

o Maintain turnaround time compliance in all aspects of the UM process.

· Referral Tracking and Reporting

o Responsible for referral authorization maintenance, tracking and follow-up

o Responsible for log maintenance and patient notifications

· Returns phone calls to patients, physicians and health plans and follow up with requests

· Follow-up on missed appointments for specialty consultations and PCP follow-up.

· Coordinate patient transportation for IBHS clinic visits

· Assist patients in connecting with other programs to address patients’ social needs, homelessness, food and clothing needs, mental health, or for substance abuse services.

· Create resource file of qualified specialty groups and county agencies in the community

· Maintain patient confidentiality so that HIPAA compliance is observed at all times

· Know and follow the Employee Handbook policies and procedures

· Maintains quality monitors as assigned by Manager

· Assist other staff and supports the team approach

· Communicates appropriately and clearly to management, co-workers, and medical team

· Additional duties as assigned

MINIMUM QUALIFICATIONS

High school diploma or equivalent. Must have experience with an electronic health system in a medical setting. One year of related experience. Must be able to accurately identify patient needs and refer them to the appropriate resource. Must have experience as a referral coordinator/utilization review coordinator. Must be able to accurately identify patient needs and refer them to the appropriate resource. Must have ability to multi-task and meet deadlines and knowledge of healthcare protocols/procedures. Ability to project a pleasant and professional image; plan, prioritize and complete delegated tasks, and demonstrate compassion and caring in dealing with others.

Preferred experience to have worked in Dr.’s offices, worked with Utilization Management (UM), knowledge of Healthcare and Managed Care, some healthcare coding.

ESSENTIAL FUNCTIONS

Must have physical ability to sit for extended periods of time, have the ability to reach, possess fine manual dexterity, talking, and hearing.

Must be psychologically able to deliver appropriate medical services to the patients regardless of ethnic, religion, sex, age, physical disability, or economic status.

Job Type: Full-time

Pay: $21.75 - $22.57 per hour

Benefits:

• 401(k)
• Dental insurance
• Employee assistance program
• Flexible schedule
• Health insurance
• Life insurance
• Paid time off
• Retirement plan
• Vision insurance

Schedule:

• 8 hour shift
• Monday to Friday
• Weekends as needed

Work Location: In person

Salary : $22 - $23