Case Management Assistant-Utilization Review

Schedule: Monday-Friday (8am-5pm)

This role is hybrid and requires 2-days in office per week.

Working weekends and holidays are required and based on operational needs.

Job Summary: The Case Management Assistant (CMA) collaborates with Case Managers and Social Workers in assisting with the continuum of care and discharge planning. Communicates clinical information, referrals and coordination of insurance review. Collaborates with the PBO (Patient Business Office) for identification of payer sources, eligibility, or indigent programs; completes TAR's (Treatment Authorization Requests) for submission to the county field offices for medical authorization, supports medical on-site reviewer functions, assists with reimbursement, authorization contracts, and supports the denials and appeals process. Functions under the direction of a Case Manager with minimal supervision, takes responsibility for professional growth, and assists in the coordination of patient placements, ordering of durable medical equipment and coordinating care transitions. Performs other duties as needed.

Education and Experience: Associate's Degree in related field preferred. Minimum three years experience with a medical group, managed care organization, utilization management, hospital admitting, or medical nursing unit required. Hospital and/or insurance experience preferred.

Knowledge and Skills: Acquires and maintains working knowledge of Medi-Cal, CCS, CMS and commercial regulations and managed care; Knowledge of state managed health plans and contracting. Able to read; write legibly; speak in English with professional quality; use computer and software programs necessary to the position; Operate/troubleshoot basic office equipment required for the position. Able to relate and communicate positively, effectively, and professionally with others; able to demonstrate positive customer service skills; work calmly and respond courteously when under pressure; lead, supervise, teach, and collaborate; accept direction. Able to communicate effectively in English in person, in writing, and on the telephone; think critically; work independently with minimal supervision; perform basic math functions; manage multiple assignments effectively; work well under pressure; problem solve; organize and prioritize workload; recall information with accuracy; pay close attention to detail; maintain confidential records and correspondence. Able to distinguish colors as necessary; hear sufficiently for general conversation in person and on the telephone; identify and distinguish various sounds associated with the work place; see adequately to read computer screens, medical records, and written documents necessary to position.

Licensures and Certifications: Medical Assistant Certification preferred.

Our mission is to continue the teaching and healing ministry of Jesus Christ. Our core values are compassion, excellence, humility, integrity, justice, teamwork and wholeness.

Loma Linda University Health is a Seventh-day Adventist, faith and values based Christian institution. Candidates must understand and embrace the mission, purpose, and identity of Loma Linda and its affiliated entities.

We are an equal opportunity employer committed to the principles of diversity. We provide equal opportunities in all aspects of the employment process to every individual, regardless of gender, race, color, age, national origin, ancestry, physical or mental disability, marital or veteran status, genetic information or any other characteristic protected by law. In addition, we will provide reasonable accommodations for otherwise qualified individuals requesting an accommodation due to a disability. If you need accommodation assistance with accessing our job listings or completing an application, or during any other phase of employment with us, please contact Human Resources Management at View phone number on aiapply.co.

Loma Linda University Medical Center is a religiously-qualified Equal Opportunity Employer under Title VII of Civil Rights Act of 1964. No question on this application is asked for the purpose of unlawfully limiting or excluding any applicant’s consideration for employment because of race, color, religion, gender, age, national origin, disability, genetic information, or any other status protected by applicable law. If you need a reasonable accommodation in the hiring process, please notify Human Resource Management.

We appreciate your interest in Loma Linda and wish you success in your job search!