What are the responsibilities and job description for the Case Manager position at Palms Medical Group?
We hire to retire! We offer our employees a work life balance and supportive team in each of our clinics that makes PALMS culture our greatest benefit. Besides a Monday through Friday set schedule and a rich PTO plan, we treat every employee like Family. Feel the difference, apply today.We hire to retire. Come join our amazing team of professionals offering total family wellness and healthcare to residents of 7 counties via our 13 offices in North Florida.PERKS : Work a Monday through Friday schedule from 8am - 5pm. Enjoy 12 PAID Holidays including your Birthday. Family focused company values for work / life balance 20 days of PTO per year. Pay increase after initial 90 days of employment, Low-cost Palms office visits and Palms Pharmacy prescriptions for employees and dependents. Position SummaryThe Case Manager is responsible for providing first class customer service and ensures that all necessary patient referral data is completed and coordinated properly, accurately and thoroughlyDescription of Primary Responsibilities Responsible for customer service Provide necessary customer and support services to patients of Palms Medical Group within his / her field of training in accordance with stated policies and procedures of PMG.Answer, screen and route telephone calls in a polite and professional manner.Answer the telephone within three (3) rings.Know how to efficiently operate a multiline telephone (transferring, voicemail and que).Document phones calls in EHR.Know all PMG departments and services.Responsible for referral processingFollows current and standardized referral policies and workflowsPrioritizes referrals by urgency and addresses them in a by established goals. Ensures complete demographic, insurance information and appropriate clinical information is sent to referral specialistsReview details and expectations about the referral with both ordering provider and patients. Explain the referral process to the patient including the steps involved, who the referral providers are and how to contact a hospital or referral specialist office.Ensure all necessary consents are available or make arrangements to obtain them.Process all incoming and outgoing patient data to ensure appropriate coordination and continuity of patient careIdentify and utilize community resources. Establish relationships with services providers and personnel.Serve as point of contact for patients and specialist for questions. Assists in problem solving potential issues related to their referral due to language or social barriers. Responsible for referral trackingFollow EHR protocols for referral tracking.Retrieve reports placed in the electronic referral folder.Record all reports received. Follow PMG policies / procedures when closing out referrals.Receive and process referrals within stated timeframes,Responsible for authorizationsContact insurance companies to ensure prior approval requirements are met. Present necessary medical information to prove medical necessity of servicesKnow which insurances require authorizations and how to document those authorizations.Responsible for administrative dutiesAdhere to the Referrals Policy Manual, Medical Records Policy Manual and HIPAA Policy ManualCheck emails at least twice daily.Maintain patient confidentiality in accordance with HIPAA regulations.Assist with audits and surveys as directed by Case Manager Coordinator Perform any other duty assigned by the Case Manager Coordinator, Executive VP of Patient Services or CEO to improve the efficiency of PMG RequirementsDescription of Primary Attributes General Development : Must be organized, a self-starter and detailed orientedJob duties require the ability to work independently and as part of a teamExpected to multitask Know referral sources in one's geographical area Professional & Technical Knowledge : 1. Employee will have a Working Knowledge of the following office equipment : Multiline TelephoneCopierComputerEmailScannerFax MachineCalculator2. Employee will be expected to navigate and operate Microsoft Office suite products, including Word and Excel Licenses & Certifications : High School Diploma or Equivalent1-year prior experience in insurance verification and referralsCommunications Skills : Effectively communicates complex and / or technical information to co-workers, patients and / or vendorsPhysical / Mental / Emotional Demands : Standing for long periods of timeSitting for long periods of timeViewing a computer monitor for long periods of timeBendingStretching / ReachingWalking short distancesLifting up to 50 poundsOperating office equipment (computer, fax machines, telephones and copy machines)Reading forms / Instructions / Patients Charts Communicating well to people of various ages, educational levels, cultural backgrounds in person or by telephoneExposure to potentially violent / irate patientsHealth / Safety Consideration of PositionExposure to chemical infectious / contagious illnessExposure to chemical and inhalation of antibiotics during reconstitutionExposure to X-Ray radiation Exposure to a variety of scents and odorsMust utilize universal precaution in clinical or exposure situations as prescribed by federal state, and local guidelines and / or laws
