Case Manager

Scope: The Case Manager Assistant assists the RN Case Manager in performing necessary functions using the Case Management process in order to meet the needs of MedWatch, LLC customers and consumers. This includes, but is not limited to, authorization of services, review of treatment plans for medical necessity, standards of care, and ongoing communication with all members of the health care team. The Case Manager Assistant performs all functions under the direct management and supervision of the RN Case Manager. This individual is expected to accurately communicate in both Spanish and English to service customers and satisfy the responsibilities outlined in this job description. Education: Licensed Practical Nursing Education preferred. Basic computer skills. Licensure/Certification Requirements: Licensed Practical Nurse or Medical Assistant/Nursing Assistant Certification (current active and unrestricted, in current state of practice and residence, within the United States or its territories) Experience: 5 years of varied clinical experience preferred, or three years in a specialty field. Requirements/Skills: Basic Computer skills. Good organizational skills and time management. Excellent verbal and written communication skills. Ability to handle difficult situations tactfully and diplomatically. Effective problem solving and decision-making skills. Strong computer skills with proficiency in MS Office Suite products. (Word, Excel, PowerPoint) Duties and Responsibilities: Must speak fluent English and Spanish with strong reading and writing abilities in each language. The Case Manager Assistant will practice within the scope of his/her licensure. The Case Manager Assistant will operate under the direct supervision of the RN Case Manager and perform Case Management functions as directed by the CM, excluding Initial Case Assessments and Formulation of the Initial Care Plan. Review all medical data which can be provided to update a Case Management plan which will incorporate contact with providers, payers, with the patient and with the patient's primary caregiver. Make contact with the payer office to find out and understand any benefit constraints that will have an impact on the plan of action. Proceed with contacting medical care providers and with equipment vendors to verify medical necessity of care or equipment that has been ordered. Make care arrangements for quality patient care according to the needs of the patient, the physician's orders and the benefits available. Be aware of any alternative treatment possibilities that may allow the patient to reach wellness goal(s). If there are no benefits available for your recommended alternative treatments, provide to the payer a cost-benefit analysis to demonstrate that extra-contractual services will enhance the patient's medical condition and will be cost-effective to the benefit plan. Become familiar with community resources and funding sources so that the patient can receive quality health care and conserve health benefit dollars. Many agencies exist which provide assistance to persons in financial need or to provide information to persons with specific medical conditions. Maintain case in computer system documenting case actions for each patient under your Assigned Case Manager's caseload, under direction of the Case Manager. Complete all aspects of case in the computer. Prepare timely reports to the payer to detail all case actions, the results of those actions, and the continuing Case Management plan, which are reviewed by the Case Manager. Maintain billing as appropriate in computer system. Continue to maintain contact with the providers and with the patient across the continuum of care to be sure that patient needs are being met. On any cases which include a chronic condition keep the file open for periodic contacts to verify the clinical status of the patient and additional medical needs. Negotiate with providers to maximize the medical benefits available to the patient. Make network referral as appropriate. Act upon any awareness of non-medical issues which involve the patient's safety or welfare. Attempt to direct the patient or family to appropriate providers or community resources, or to personally notify appropriate authorities in consultation with the Case Manager. Consult with the Case Manager on a regular basis and keep the Director of Case Management informed regarding any complaints which may occur about Case Management services or any issues which arise which the Case Manager assistant is not competent to handle or does not have the expertise to handle. Adhere to all company policies as stated in the employee handbook. Participate in the Quality Management Program by adhering to all company policies and procedures and identifying opportunities for improvement to ensure quality services are rendered to clients and customers. The incumbent may be responsible for duties or responsibilities that are not listed in this job description. Duties and responsibilities may change at any time with or without notice. There is a pay differential for Bilingual - Spanish speaking requirement.The salary range for this position is from $23 to $27 per hour. Work Environment / Physical Demands: This position is in a typical office / home office environment which requires prolonged sitting in front of a computer. Requires hand-eye coordination and manual dexterity sufficient to operate standard office equipment including operation of standard computer and phone equipment. We are an Equal Opportunity Employer, including disability/veterans. #J-18808-Ljbffr