Case Management Assistant (PHM)- Bakersfield 1.1

Job Description

Job Description

Description:

Employment Details:

Location: Bakersfield, CA. (Onsite)

Classification: Full-Time

This position is non-exempt and will be paid on an hourly basis.

Schedule: Monday-Friday 8am-5pm

Benefits:

· Medical

· Dental

· Vision

· Paid Time Off (PTO)

· Floating Holiday

· Simple IRA Plan with a 3% Employer Contribution

· Employer Paid Life Insurance

· Employee Assistance Program

Compensation: The initial pay range for this position upon commencement of employment is projected to fall between $19.34 and $24.17. However, the offered base pay may be subject to adjustments based on various individualized factors, such as the candidate's relevant knowledge, skills, and experience. We believe that exceptional talent deserves exceptional rewards. As a committed and forward-thinking organization, we offer competitive compensation packages designed to attract and retain top candidates like you.

Position Summary:

The Case Management Assistant (CMA) provides administrative and care coordination support to the Population Health Management (PHM) team, including Nurse Case Managers and Social Services staff. The CMA assists by conducting outreach, gathering and organizing information, coordinating appointments and referrals, documenting activities, and helping to address routine member needs. This role is member-focused, ensuring individuals receive timely communication, follow-up, and access to services and resources. The CMA supports member engagement activities such as wellness calls, enrollment outreach, and care gap closure, helping to improve the overall member experience and promote better health outcomes. The CMA requires strong interpersonal and organizational skills to communicate effectively with members, assist with referrals, and help coordinate services among providers, community resources, and internal care teams. The CMA also supports the Interdisciplinary Care Team (ICT) activities by gathering information, preparing documentation, and relaying member needs to the case management team.

Requirements:

Job Duties and Responsibilities:

• Work collaboratively with Nurse Case Managers and Social Services staff on care coordination, member follow-up, communication with agencies.

• Support PHM outreach activities by conducting calls for program enrollment, Health Risk Assessment (HRA) completion and other relevant questionnaires, wellness checks, and quality initiatives to help close care gaps.

• Contact members at regular intervals per their acuity level and care plan needs.

• Document all outreach, coordination activities, and member interactions in the case management system (CM System) accurately and in a timely manner, in alignment with program protocols.

• Support members experiencing transitions of care by assisting case managers with coordination of post-discharge needs, follow-up appointments, and transportation.

• Gather clinical information and assist with coordinating services such as home health care, prescriptions, durable medical equipment (DME), and social service referrals.

• Prepare and send member correspondence, as directed by case managers or in alignment with case management protocols.

• Report and escalate member concerns, variances, or changes in condition to the appropriate care team members to ensure timely intervention and coordinated follow-up.

• Assist members with appointment scheduling, transportation, referral coordination, and other care coordination needs.

• Gather clinical information from outside sources such as PCPs, specialists, hospitals, SNFs, and electronic health records, and upload them into the case management system.

• Verify member eligibility, demographics, and benefits; confirm provider assignments to ensure authorizations are linked appropriately.

• Support closed-loop referrals to community supports, housing, and social service agencies, with follow-up to confirm services were delivered.

• Participate in ICT meetings by gathering and presenting information and communicating member needs and preferences to the care team.

• May be assigned to manage a caseload of low-acuity PHM members, under the supervision of Nurse Case Managers or Social Services staff.

• Serve as an associate and resource to members, providers, staff, and external customers regarding policies, benefits, and care coordination.

• Provide administrative support, including answering phones, assisting with correspondence, filing, scanning, and maintaining department data systems.

• Receive and route incoming faxes, medical records, and other documentation to the appropriate case management staff.

• Track and log outreach attempts and results in the case management system to support reporting and follow-up.

• Conduct outreach to members to verify needs are being met and services delivered.

• May be assigned to conduct in-person meetings with members during clinic visits.

• Assist with training and orientation of new staff, as requested.

• Assist case management team with oral interpretation, as applicable.

• Attend mandatory staff and departmental meetings.

• Perform other duties as assigned.

Qualifications:

• High School diploma or GED required.

• Minimum of 3 years of experience in a healthcare or community health setting.

• Knowledge of case management processes and regulatory requirements for Medi-Cal, Medicare, and commercial programs preferred.

• Experience in a managed care environment preferred (IPA, HMO, or health plan).

• Medical Assistant or Community Health Worker certification preferred.

Knowledge and Skills:

• Ability to respect the needs of members, support givers, team members, and others, and provide excellent customer service.

• Willingness to collaborate as part of a team with professionals at all levels to achieve shared goals and remove barriers to member health.

• Sensitivity to members' social, cultural, language, physical, and financial differences.

• Ability to work with members and influence behavior through negotiation of care goals and support of member self-management.

• Strong problem-solving skills and ability to identify issues and propose solutions.

• Ability to prioritize tasks based on changes in member situations and needs.

• Ability to work independently, organize and prioritize multiple tasks throughout the day.

• Strong attention to detail and ability to be accurate, thorough, and persistent in problem solving and task completion.

• Excellent verbal and written communication skills, with the ability to communicate effectively with all levels of the organization and members.

• Proficiency in creating professional documents with proper grammar and punctuation.

• Ability to maintain professionalism and adapt to a changing environment.

• Ability to understand and communicate complex health and benefit information.

• Proficient in the use of common office technology, including electronic Case Management systems.

• Reliable in attendance and adherence to work schedule and business dress code.

• Ability to always maintain strict confidentiality.