Case Management Assistant, ECM - Fresno 1.1

Case Management Assistant

The Case Management Assistant provides support for the Case Management Department, including the Nurse Case Managers and Social Services team specifically through the coordination of services within the Enhanced Care Management (ECM) Program.

The Case Management Assistant will provide support by managing low acuity cases, assisting in enhanced care coordination activities, monitoring members, reporting findings, and gathering clinical information from outside sources.

The ECM Program addresses the clinical and non-clinical needs of members with the most complex medical and social needs through systematic coordination of services and comprehensive care management.

ECM is intended to service those with chronic health conditions, are homeless or at-risk, with high hospital admissions, substance abuse, and/or behavioral health needs. This position requires strong interpersonal and organizational skills to build rapport with members, coordinate referrals, and care amongst various healthcare providers and community services.

The Case Management Assistant also works with the member's inter-disciplinary team (ICT) supporting the member, while engaging the member and their support systems to define priorities that are central to the member's desired needs and goals.

Requirements

• Effectively manage low acuity member cases within the ECM Program.

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

• Completes member questionnaires or assessments, and consistently document care management activities and encounters in the CM System, per program protocol.

• Works collaboratively and assists clinical and social services Case Managers with care coordination, member follow-up, communication with appropriate agencies and preparation and distribution of documents and/or reports.

• Works collaboratively and assists the Clinical or Social Services Case Managers to manage members in need of Transitional Care Services (TCS).

• Gather clinical information and assists with coordinating post-discharge services, including scheduling provider appointments, ensuring post-discharge referrals are received by the member, transportation to appointments is arranged, and members are aware of follow-care needs.

• Proactively initiates care transition coordination with referral sources and internal partners to ensure seamless patient transitions to home or ATS. Participates with any data collection required for therapy start and patient tracking process. This may include facilitating the transfer of orders via phone, fax, and e-prescribing.

• Reports variances and issues to nursing or social services staff assigned to the member.

• Assists members with appointment scheduling, transportation, referral coordination, and other enhanced care coordination services.

• Responsible for gathering clinical information from outside sources such as PCPs, specialists and other providers, electronic health records, and other partnering entities.

• Verifies member eligibility, demographic information, and benefits.

• Verifies member's Primary Care Physician and the Physician Specialist to ensure that authorization is requested and issued to appropriate network provider.

• Assists in maintaining the integrity of the data systems by entering information into department's data systems.

• Provides general office administration duties including answering phones.

• Provides general customer service to all potential and exiting ECM members and partnering agencies.

• Gathers relevant information for the identified member population during assessment, care planning, interdisciplinary care team meetings, and transitions of care.

• Outreaches to members to verify that needs are being met, and services are being delivered.

• Intervenes at the member level to coordinate the delivery of direct services to the member and their families.

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

• Assists with system letters, requests for information and data entry.

• Gather information, present, and participate in Interdisciplinary Care Team (ICT) meetings, and communicate the member's needs and preferences in a timely manner to the member's multi-disciplinary care team.

• Attend mandatory departmental and staff meetings.

• Assist with training and orientation of new staff.

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

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

• Performs other duties as assigned.

Qualifications

• Education: High School diploma or GED required.

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

• Knowledge of prior authorization or case management regulations governing Medi-Cal, Commercial, Medicare, CCS, and other government and commercial programs.

• Experience in a managed health 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 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.