Care Management Assistant at PIONEERS MEMORIAL HEALTHCARE DISTRICT – Brawley, California

SUMMARY:

The Care Management Assistant (CMA) is Responsible for sending out clinical data to payors, issuing IMM and MOON letters, scheduling PCP appointments, securing authorizations, completing TARs and CCS referrals, arranging appeal packets, ordering office supplies, checking phone voicemail and setting up peer to peers.

ESSENTIAL FUNCTIONS:

The following description of job responsibilities and standards are intended to reflect the major responsibilities and duties of the job but are not intended to describe minor duties or other responsibilities as may be assigned from time to time.

• Provides accurate clinical information to specific insurance companies for the purpose of obtaining authorization for the hospital stay with support from the utilization review nurse.
• Secures authorizations for continued stay daily or as per health plan. Documents in Midas.
• Reports potential denials to Lead utilization nurse.
• Provides notification of discharges to insurance payors.
• Post-discharge secures authorizations for the stay. Documents in Midas.

• Prioritizes and organizes cases effectively to achieve timely and appropriate patient disposition.
• Obtains consents for referrals and transfers as needed. Uses the Preference Letter.
• Coordinates the completion of and transmits information to community agencies to obtain a decision consistent with the transitional plan for care, i.e., home health care, nursing home, other transfer/discharge destinations, LTACHs and services as directed.
• Prepares transfer packet and required clinical and financial information and ensures the information is faxed or email to appropriate agencies.
• Obtains the durable medical equipment as prescribed by the physician or directed by the case manager and any authorizations needed for the equipment.
• Responsible for timely delivery documentation and tracking Medicare “Important message” notices to Medicare patients or Representative. Documentation of IM letter in Midas, File signed IM letter in patient’s chart, and provide patients with a copy.
• Assists as needed with coordinating the hospital's activities in response to the discharge appeal. May collaborate with Care Management, HIM and the QIO to transmit required information during an appeal.

• Responsible for Referring and Securing Coverage for CCS patients.
• Maintains positive interaction and relationships with Medical Records, Patient Accounting, Admissions, and Information Systems.

• Performs other job-related tasks as requested by the Manager of Utilization Review/Discharge Planning.
• Participate in quality improvement processes, as appropriate.

OTHER RESPONSIBILITIES:

Other duties as assigned from time to time.

SUPERVISORY RESPONSIBILITIES:

None.

EDUCATION, KNOWLEDGE, SKILLS, ABILITIES, AND EXPERIENCE:

LICENSES AND CERTIFICATIONS:

None.

AGE OF POPULATION SERVED:

Newborn  Infant/Pediatric  Adolescent  Adult  Geriatric  All  No Patient Care X