Job Details

Job Title: Non-Clinical - Administrative - Case Management Assistant
Location: Santa Rosa, CA  (ONSITE)
Contract Duration: 13 weeks
Working Hours: Day 5x8-Hour (08:00 - 16:30)
Total Weekly Hours: 40hrs

GENERAL SUMMARY
Case management is a patient care delivery process which supports the patient's body, mind and spirit. The healing process is facilitated by coordination of appropriate services and resources along the continuum. The resource coordinator supports all team members in the case management process.

ESSENTIAL FUNCTIONS
The job duties listed are essential functions of the position. However, other duties may be assigned, and may also be considered essential functions of the position. The caregiver must be sufficiently fluent in the English language to satisfactorily perform the essential functions of the position. The degree of fluency required will vary depending upon the nature of the position. Caregivers are expected to honor the Mission, Values, Vision and Promise and adhere to the Code of Conduct, policies and standards of their organization. For direct patient care roles: Performs and maintains currency of essential competencies as required by specific area of hire and populations served.
• Supports the case management process by carrying out administrative and other tasks as necessary to achieve desired quality and efficiency outcomes identified by the multidisciplinary team.
• Obtains insurance and benefit verifications to assure reimbursement and continuity of care.
• Collects and maintains data important to the case management and outcome management process.
• Distributes patient information in support of the continuum needs of the patient.
• Facilitates exchange of information to achieve timely and efficient transfers/discharges of patients to other levels of care.
• Participates in designated meetings and committees of value to the case management process.
• Continuum of Care:
• Assists with special projects relative to the case management process.
• Inputs accurate data for claims payment and utilization trending.
• Acts as a resource to hospital staff, physicians, patients, families and providers re: discharge planning and community resources.
• Coordinates requests for DME, oxygen, home health.
• Coordinates referrals to lower level of care facilities.
• Assists with coordination of transfers to other facilities.
• Assists with home health referrals.
• Copy or request medical records as necessary to facilitate certifications of stay.
• Compiles and updates community resource files.
• Determines patient eligibility and benefits.
• Refers patients to financial counselors/eligibility workers if unfunded.
• Facilitates MediCal applications.
• Obtains authorizations.
• Coordinates transportation.
• Maintain denial log.
• Coordinate MediCal fax review.
• Assist with completion of non-coverage letters.
• Compile routine appeal requests.
• Communicate referrals to CCS.
• Fax medication authorizations.
• Distribute UR requests to appropriate case managers.
• Assist in maintaining department schedule.
• Data entry as assigned.
• Facilitate completion of EMTALA, transfer and referral forms.