Care Manager

Job Description

Job Description

Description Summary:

Under general supervision from the Chief Medical Officer (CMO) the Care Manager (Medical Referral Tracker/Specialist) primary function the timely and accurate processing of incoming and outgoing referrals; responsible for providing health center patients with specialty care/referral options; respond to inquiries from patients , staff, internal and external physicians, hospitals, other medical groups and third party carriers; maintain data and referral tracking system; work collaboratively with other members of patient care team to support superior care delivery and excellent customer service.

Essential Functions: The list that follows is not intended as a comprehensive list, but rather to provide a representative summary of the major duties and responsibilities. Incumbent(s) may not be required to perform all duties listed, and may be required to perform additional, position-specific tasks.

1. Maintain ongoing tracking and appropriate documentation on referrals to promote clinic team awareness and ensure patient safety using the Electronic Health Record (EHR) or other established system.

2. Schedule and confirm patient diagnostic appointments, surgeries and medical consultations.

3. Maintain referral records and report on data.

4. Performs patient referrals and authorizations by completing and submitting documents and discussing with providers, insurance carriers and patients.

5. Ensure that follow-up referral appointments and reports were kept and received.

6. Prepare medical records prior to patient visit.4. Documents in HER doctors and nurse’s orders.

7. Sorts documents by procedure type.

8. Directs patients to scheduler for referral appointments. May schedule referral appointments directly on behalf of patient.

9. Directly contacts health care specialist to confirm patient’s referral complete and/or to obtain necessary reports and/or medical records to patient’s EHR.

10. Point of contact for patients on referral progress updates.

11. Coordinated with clinical team on patient inquiries regarding referral.

12. Responsible for referral report management and reporting to supervisor.

13. Responsible for audit information entered in EHR to ensure compliance with capturing necessary data as required by reporting agencies (i.e. UDS, MU, etc.).

14. Utilizes EHR functions to document all pertinent information.

15. Organizes and prioritizes workload based on acuity.

16. Maintains confidentiality by following all applicable HIPAA regulations.

Non-essential Functions: Assist with any other duties as assigned. Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.

May serve as a documentation assistant, who transcribe information during clinical visits in real time into electronic health records (EHRs) under physician supervision. Enters notes, documentation, orders and or referrals.

Position requirements / Job qualifications:

Education and Training:

Minimum education- High School diploma or equivalent; An associate’s degree preferred. Minimum two (2) years’ experience in medical referrals, or other related medical patient support functions in a clinical setting.

Other Training, skills and experience requirements:

Filing, computer skills, knowledge of medical terminology and keyboarding. Employee must demonstrate, on an ongoing basis, the ability to develop and maintain good working relationships with co-workers and other departments.

Physical/mental demands:

Physical and mental demands are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions.

While performing the duties of this job, the employee is regularly required to talk or hear, sit, and use hands to finger, handle, or feel objects, tools, or controls. The employee is occasionally required to stand, walk, climb, balance on two feet, stoop, kneel, crouch, or reach with hands and arms. The employee must occasionally lift and/or move up to 25 pounds. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception, and the ability to adjust focus. Mental demands include the ability to learn, adapt to changes, and become proficient quickly, pay close attention to details, courteous and professional demeanor, ability to deal with stress of meeting deadlines and adhere to company policies and procedures.

Licensure and Credentials: N/A

Work environment:

Controlled office setting. The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The noise level in the work environment is usually moderate.

OSHA Blood Borne Pathogen Exposure Classification:

☐Category I: Job classification includes ALL employees who have occupational exposure* to blood borne pathogens* (blood or body fluids) while performing their job duties.

☐Category II: Job classification includes employees who are likely to have SOME occupational exposure to blood borne pathogens because Category I tasks may occasionally be required.

☒Category III: Job Classification includes those employees who perform jobs and tasks where NO CONTACT with blood borne pathogens occurs and Category I and Category II tasks ARE NOT a condition of employment.