Job Summary: The Case Management Assistant is responsible for assisting with case management in the daily utilization management functions of authorization, referrals, claims analysis, claims payment, data entry and chart review. Demonstrates working knowledge of managed care contract rates, terms, and conditions and accurately identifies member benefits. Cross covers all key areas of utilization management to ensure compliance with regulations. Functions independently with minimal supervision and takes responsibility for professional growth. Performs other duties as needed.
Education and Experience: High School Diploma or GED required. Certificate or degree in business or healthcare field preferred. Minimum two years of experience with a home care agency, medical group, business office or managed care office required.
Knowledge and Skills: Able to keyboard 40 wpm. Able to use a computer, printer, and software programs necessary to the position (e.g., Word, Excel, Outlook, PowerPoint). Operate/troubleshoot basic office equipment required for the position. Able to work calmly and respond courteously when under pressure; collaborate and accept direction. Able to think critically; manage multiple assignments effectively; organize and prioritize workload; work well under pressure; problem solve; recall information with accuracy; pay close attention to detail; work independently with minimal supervision. Able to distinguish colors as necessary; hear sufficiently for general conversation in person and on the telephone, and identify and distinguish various sounds associated with the workplace; see adequately to read computer screens, and written documents necessary to the position.
Licensures and Certifications: LVN ,MA or Managed Care related national certification preferred. Valid driver's license required at time of hire.