Non-Clinical - Administrative - Case Management Assistant

Case Management Coordinator

The Inpatient Case Management Coordinator plays a critical role in supporting case managers and social workers by coordinating care, managing documentation, and ensuring timely communication with members, providers, outside facilities, and internal teams. The Case Management Coordinator will work closely with case managers, social workers, providers, and interdisciplinary teams to facilitate care coordination. This position requires strong organizational skills, attention to detail, and an understanding of managed care processes to facilitate seamless transitions of care and optimize patient outcomes. The Case Management Coordinator assists with the management of members in PIH, Out of Network, and SNF facilities.

Specific skills needed include a high level of communication skills demonstrating courtesy and professionalism, excellent organizational skills, problem-solving and decision-making abilities, strong attention to detail, and the ability to manage multiple tasks in a fast-paced environment. Proficiency in Windows, Microsoft Word, and Excel is required, along with a minimum typing speed of 40 wpm. Knowledge of medical terminology is also necessary.

Education/experience/training required includes a high school diploma or GED and a minimum of two years of experience in the health care field. Experience in case management, managed care, or healthcare coordination is preferred, as is Spanish speaking ability.

Duties and responsibilities include safeguarding and preserving the confidentiality of patient's protected health information in accordance with State and Federal (HIPAA) regulatory requirements, hospital, and departmental policies; ensuring a safe patient environment and adherence to safety practices per policy; utilizing the approved process to resolve biophysical, psychological, educational, and environmental needs of patient/significant other when administering care; updating daily census reports by verifying member admissions and discharges; communicating with members via phone and in person to assess needs, triage concerns, and facilitate problem-solving; collaborating with case managers and social workers, including the leadership team as needed; verifying member eligibility and benefits to support care coordination efforts; maintaining understanding of managed care principles, risk arrangements, delegation of financial responsibility (DOFR) and compliance requirements; scheduling member appointments and arranging transportation as needed; conducting follow-up calls with discharged patients to address ongoing needs and coordinate post-discharge care; entering and updating all inpatient admission authorizations accurately; assisting case manager with creating authorizations required for safe discharge; facilitating delivery and tracking of required forms to adhere to health plan requirements; preparing and distributing daily reports for patient rounds to ensure up-to-date patient information; receiving, reviewing, labeling, and filing incoming faxes daily to maintain accurate records; ensuring complete and accurate documentation in accordance with organizational and regulatory standards; assisting in completing of health plan reports, ensuring accuracy, and maintaining up-to-date logs; fostering positive, professional relationships with physicians, facility staff, and colleagues; adhering to PIH Enterprise policies and procedures, ensuring high-quality customer service; working efficiently in a fast-paced environment, exhibiting strong multitasking abilities and attention to detail; engaging in professional development by attending department meetings, completing required trainings and participating in process improvement initiatives; assisting in training new hires to ensure a smooth onboarding process; providing coverage for team members as needed; and performing other duties as assigned.

Teamwork/customer service responsibilities include treating each person with respect, dignity, fairness, and compassion; displaying loyalty and pride in PIH Health and upholding the confidentiality of patients, visitors, physicians, and co-workers; demonstrating commitment to open communication; and demonstrating pride in the physical appearance of all PIH Health properties.

Personal qualities include the ability to recognize differing values and be culturally sensitive, the ability to make good decisions, set priorities, and follow through on assigned tasks, a professional attitude and appearance, commitment to the organization for which you work, the ability to maintain strict confidentiality, and interacting in a professional, courteous, and patient-focused manner with all members of the organization.