Case Management Assistant

Overview
***This position will be hybrid in-office and remote/work from home.
The purpose of Dignity Health Management Services Organization (Dignity Health MSO) is to build a system-wide integrated physician-centric full-service management service organization structure. We offer a menu of management and business services that will leverage economies of scale across provider types and geographies and will lead the effort in developing Dignity Health’s Medicaid population health care management pathways. Dignity Health MSO is dedicated to providing quality managed care administrative and clinical services to medical groups hospitals health plans and employers with a business objective to excel in coordinating patient care in a manner that supports containing costs while continually improving quality of care and levels of service.
Dignity Health MSO accomplishes this by capitalizing on industry-leading technology and integrated administrative systems powered by local human resources that put patient care first.Dignity Health MSO offers an outstanding Total Rewards package that integrates competitive pay with a state-of-the-art flexible Health & Welfare benefits package. Our cafeteria-style benefit program gives employees the ability to choose the benefits they want from a variety of options including medical dental and vision plans for the employee and their dependents Health Spending Account (HSA) Life Insurance and Long Term Disability. We also offer a 401k retirement plan with a generous employer-match. Other benefits include Paid Time Off and Sick Leave.
Responsibilities
Position Summary:
The Case Management Assistant provides support for the Clinical Services Department, including Outpatient Case Managers, Social Services team, and Health Education, specifically through the coordination of services within the Dignity Health MSO Clinical Programs and Dignity Health MSO Case Management program.
The Case Management Assistant serves as an intake coordinator for referrals into disease management program(s), coordinating requests for services, monitoring members, and reporting findings. The Case Management Assistan is responsible for gathering clinical information from outside sources such as PCPs, specialists and other providers, hospital logs, Cerner, PCM, hospital case managers, and outpatient UM staff.
Responsibilities may include:

• Facilitates communication between providers, Dignity Health MSO staff, hospital physicians, patients and their families with regard to coordination of services.
• Contacts members who are identified as appropriate for medical management program(s).
• Explains process for telephonic management to members and obtains member consent to participate.
• Contacts program participants at regular intervals to evaluate health status according to program protocol.
• Reports variances to nursing staff assigned to the patient.
• Maintain accurate records of referrals, appointments, evaluation and management process for the Clinic and Case Management program.
• Responsible for insuring all authorizations are received by the appropriate parties.
• Responsible for gathering clinical information from outside sources such as PCPs, specialists and other providers, hospital logs, Cerner, PCM, hospital case managers, and outpatient UM staff.

- Verifies member eligibility, demographic information, and benefits as follows: Health plan eligibility or certificate number, Effective date of coverage, Cancellation date if member is dis-enrolled, Patient address and phone number ensures information is up-to-date, Health plan and benefit options - ensures authorization is issued to appropriate member for appropriate benefit, Verifies benefits per company policy for appropriate services.

• May assist with other clerical duties, including data entry, chart preparation, report generation and appointment scheduling, ordering supplies for the departments, general support for Case Management, Social Services and Health Education.
• Other duties as assigned.

Qualifications
Minimum Qualifications:

• 
  Two (2) or more years of experience in a medical office and/ or health plan insurance office. Two (2) or more years of experience utilizing medical or healthcare platforms/ systems (i.e. EMR, HIN, patient registration software). Basic to intermediate experience with Microsoft Office.
• High school diploma and/ or GED required.
• Knowledge and understanding of IPAs, PPOs, and HMOs with regard to benefits, policies and procedures, documentation requirements and medical terminology.
• Must have strong oral and written communication skills as well as organizational and project management skills.

Preferred Qualifications:

• 
  QNXT and/ or Cerner applications preferred.
• Medical Assistant (MA) Certificate from an accredited vocational school.