Case Management Assistant-Case Management Social Services

Job Objective:

Provides clerical support to Case Managers, Social Workers and other members of the department in order to maintain efficient discharge planning processes and department operations.

Essential Responsibilities:

• Demonstrates compliance with Code of Conduct and compliance policies, and takes action to resolve compliance questions or concerns and reports suspected violations.
• Assists in referring and faxing of discharge referrals to outside agencies (skilled nursing, sub-acute and acute care facilities, transitional care, rehab services, home health agencies, DME companies and other providers).
• Assists in facilitating acquisition of appropriate insurance information and authorization prior to discharge.
• Assists in ensuring completion of all necessary post discharge paperwork and sends to provider as directed.
• Confirms agency/facility acceptance and time of transfer; makes transportation arrangements as directed; routinely and timely communicates this information via email and/or verbally to appropriate Case Manager, Social Worker or Nurse Navigator.
• Performs phone calls and faxes information to complete Medi-Cal
• Communicates results of Medi-Cal
• Assists in preparing patient packets when needed, i.e., by copying medical records, printing reports from computer, collating required information and preparing transfer envelope.
• Communicates with leadership when issues or needs for process changes are identified.
• Maintains community resource list.
• Assists in the distribution of Medicare IMM letters and in obtaining signatures, if applicable.
• Assists with Medicare appeals by gathering all information, faxing to the QIO, confirming that information was received, completing log, following up on outcome and communicating with appropriate team, if applicable.
• Assists in making PCP post discharge appointments of high risk patients as needed to prevent readmissions.
• Assists in taking-off and communicating voice mail messages.
• Asks for help when necessary and willingly assists co-workers when necessary to promote efficiency and to provide quality service.
• Determines priority in workload; completes a typical day’s assigned workload within the scheduled shift.
• Maintains current knowledge and awareness of payer reimbursement practices and regulations impacting the patients plan for care and discharge plan.

Essential Skils:

• Ability to use Microsoft Office Suite (Word, Excel, Outlook, PowerPoint) and other relevant software applications
• Self-starter; driven to take action without needing prompting
• Written and verbal communication skills
• Ability to effectively communicate in a positive and professional manner
• Knowledge of payer types including Medicare, SR HMO , Medi-Cal and Private Payers
• Problem solving skills to identify issues and formulate effective solutions