Case Management Assistant - Referrals

Job DetailsLevel: EntryJob Location: Involuntary Remote TMC - Remote, SC 29486Position Type: Full TimeEducation Level: High School Diploma or GEDSalary Range: $18.00 - $22.00 HourlyTravel Percentage: NoneJob Shift: DayJob Category: Admin - ClericalPOSITION SUMMARY:

Work directly with the Supervisor and Manager to provide additional resources for the case management staff. This position does not provide any clinical review or decisions.

This individual is responsible for monitoring incoming correspondence received.  The coordinator will ensure the referrals are set up in the case management system and promptly assigned to the case manager. The Referral Coordinator will answer incoming calls, screen, respond and route the calls. This position requires the ability to work independently to meet deadlines, as well as an excellent phone demeanor and a desire to provide exceptional customer service. The position requires knowledge of medical terminology, the understanding of referral criteria by client and/or jurisdictions. The referrals may be for WC Utilization Review and or Case Management services.

Responsibilities of the position include, but are not limited to:


Set up of member within the case management system
Assist incoming calls to the case management referral department
Monitor dedicated referral emails to review for new referrals and correspondence



Monitor workflow of referrals and identify areas where daily assistance is needed
Work with the branch locations and staff to complete and provide necessary information for referrals 
Process all referrals and correspondence within 24 hours of receipt
Maintain daily/monthly referral logs
Identify trends and/or issues in referral patterns and communicate them with management.


***Other duties as assigned

 

 

 

Additional Functions and Responsibilities


Demonstrates ability to meet administrative requirements, including productivity, time management and Quality Assurance standards
Maintain documentation standards adhering to URAC standards and company policy and procedures
Maintain confidentiality- Knowledge of laws and regulations pertaining to HIPPA and PHI
Other job duties as assigned

QualificationsEducation:  High school diploma required. Medical or Managed Care background preferred and/ or Certified Medical Assistant

Experience: Experience in healthcare and or managed care related fields, Minimum of one year of working in a medical or managed care environment preferred. Medical Terminology preferred.

 

Knowledge, Skills and Abilities: 


Experience in healthcare related fields
Strong communication skills; customer service mindset; team player.
Adheres to professional standards, codes of ethics, system and department policies and procedures. 
Incorporates the philosophies of continuous quality improvement, customer service and teamwork into daily routine
Excellent typing and keyboard skills (35-40wpm)
Ability to work in a variety of computer systems proficiently
Ability to navigate a Windows environment, utilize Outlook, and the ability to create, edit, save and send documents utilizing Microsoft Word and Microsoft Excel
Ability to work within a paperless environment


Equipment Operated/Used:

Essential Equipment: Desk, Telephone/Fax, Computer Keyboard, Mouse, System Applications

Essential Tools: Pens, pencil, computer, Keyboard

Essential Vehicles:  N/A 

Special Equipment or Clothing:

Professional attire adhering to the Company Dress Code

 

Here is some benefits that you can enjoy in this role:


Medical, Dental & Vision Insurance
Life & Disability Insurance
401(k) Plan
Paid time off
Paid holiday


 

 





                             MENTAL AND PHYSICAL REQUIREMENTS




1.  MENTAL EFFORT

 

a.  Reasoning development:

 

          Follow one- or two-step instructions; routine, repetitive task.

 

          Carry out detail but uninvolved written or verbal instructions; deal with a few concrete                            variables.

 

          Follow written, verbal, or diagrammatic instructions; several concrete variables.

 

 X      Solve practical problems; variety of variables with limited standardization; interpret instructions.

 

          Logical or scientific thinking to solve problems; several abstract and concrete variables.

 

          Wide range of intellectual and practical problems; comprehend most obscure concepts.




b.  Mathematical development:

 

          Simple additional and subtraction; copying figures, counting, and recording.

 

          Add, subtract, multiply, and divide whole numbers.

 

 X      Arithmetic calculations involving fractions, decimals, and percentages.

 

          Arithmetic, algebraic