Under the direct supervision of the Community Care Manager, RN and in collaboration with the Care Management Team, the Care Management Assistant will be responsible for the timely processing, documenting, and follow up of Care Management documentation in accordance with the Community Based Care Management program.
To succeed in this role, the Care Management Assistant should have excellent time management and communication skills, as he/she will collaborate with patients, family members/caregivers, internal teams, and external teams to deliver results.
Essential Functions of the Job:
Receives notification of interest for Community Based Care Management program enrollment from Toll-Free number, Transition of Care documentation, referral form, fax line, e-mail, mail, and/or external facilities.
Checks Community Based Care Management program eligibility requirements.
Tracks, monitors, and reviews program availability or waitlist status for potential participants.
Assigns a Care Management Team to the potential participant, schedules the initial assessment, and keeps track of upcoming appointments.
Requests/receives participant records from Primary Care Provider (PCP) or works with the potential participant or their circle of support to establish a PCP.
Requests/receives participant documentation from DHCS.
Obtains Community Based Care Management program authorizations from DHCS via phone, writing, or electronic media. In addition, follows-up on missing documentation to obtain authorization or scheduling when appropriate.
Responds to inquiries as to current status of authorization by assessing the request and evaluating the circumstances to provide the correct information.
Reviews, tracks, and monitor Medi-Cal and Community Based Care Management program continued eligibility.
Files, uploads, and keeps up to date assigned patient files.
Uses various computer systems to obtain information, schedule appointments, query information, and obtain patient documentation.
Provides data entry and report generation as needed.
Additional Duties and Responsibilities:
Maintains established departmental policies and procedures, objectives quality assurance programs, safely, environmental and infection control standards.
Enhances professional growth and development through participation in educational programs, current literature, in-service meetings and workshops.
Attends meetings as required and participates in committees as directed
Performs other related duties as assigned or requested.
Education Required (Minimum level of education):
High school diploma or GED equivalent.
CA drivers license with appropriate insurance coverage
Experience Required (Minimum level of experience):
A minimum of 1 year experience in healthcare setting to include front with back office or referral authorization knowledge of programs and health plans eligibility and guidelines. Medical Assistant Certificate or Business Office Administration Certificate in lieu of experience.
Verbal and Written Skills Required to Perform the Job: Good verbal and written communication skills. Bilingual (English/Spanish) preferred but not required.
Technical Knowledge and Skills Required to Perform the Job: Medical terminology and basic computer. Typing of 35 wpm. Ability to handle multiple activities simultaneously. Be attentive to patient needs and concerns. Willing to work with others as a team member.
Equipment Used: Personal computer, Nextgen, FAX, additional software, as required.
San Ysidro Health is a Federally Qualified Health Care organization committed to providing high quality, compassionate, accessible and affordable healthcare services for the entire family.
The organization was founded by seven women in search of medical services for their families and community. Almost 50 years later, San Ysidro Health now provides innovative care to over 92,000 patients through a vast and integrated network of 34 program sites across the county. San Ysidro Health could not serve our patients without the dedication of our passionate and hardworking employees.
Apply today and become a part of our mission-driven team!
San Ysidro Health has a long-standing commitment to equal employment opportunity for all applicants for employment. Employment decisions including, but not limited to, those such as employee selection, performance evaluation, administration of benefits, working conditions, employee programs, transfers, position changes, training, disciplinary action, compensation, and separations are made without regard to reace, color, religion (including religious dress and grooming), creed, national origin, nationality, citizenship status, domestic partnership status, ancestry, gender, affectional or sexual orientation, gender identity or expression, marital status, civil union status, family status, age, mental or physical disability (including AIDS or HIV-related status), atypical heredity cellular or blood trait of an individual, genetic information or refusal to submit to a genetic test or make available the results of a genetic test, military status, veteran status, or any other characteristic protected by applicable federal, state, or local laws.
San Ysidro Health Center