Case Management Assistant - Referrals

## Medical Case Management Assistant - Referrals

**This is a remote position.**

**The preferred hours for this position is 9 am - 5:30 pm Pacific time or 12 pm - 8:30 pm Eastern time.**

**POSITION 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

• **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

## Qualifications

Education: 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

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| **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, and geometric calculations. Advanced mathematical and statistical techniques such as calculus, factor analysis, and probability determination. Highly complex mathematical and statistical techniques such as calculus, factor analysis, and probability determination; require theoretical application. |

| c. Language development: Ability to understand and follow verbal or demonstrated instructions; write identifying information; request supplies verbally or in writing. Ability to file, post, and mail materials; copy data from one record to another; interview to obtain basic information such as age, occupation, and number of children; guide people and provide basic direction. Ability to transcribe dictation; make appointments and process mail; write form letters or routine correspondence; interpret written work instructions; inte |