Care Management Assistant :

Care Management Hoag Health System - 4.0 Newport Beach, CA Job Details 14 hours ago Qualifications Medical performance measurement report preparation Some college Appeals Skilled nursing facility experience Microsoft Excel Database systems Microsoft Outlook Process audits Utilization review Medical software Insurance claim appeals processing Licensed Clinical Social Worker Mid-level Quality reports Administrative experience Transitional care planning in clinical case management Acute care facility experience Medical administrative support Bachelor's degree Data management Quality control Medical billing and coding communication with insurance companies Medical insurance appeals management Insurance provider collaboration Home health Continuous quality improvement (CQI) Managing patient records Care coordination Managing patients as a clinical case manager Home health agency experience Full Job Description Primary Duties and Responsibilities Under the supervision of the Supervisor, the Care Management Assistant performs essential duties to the provision of Care Management for Hoag Hospital and its affiliates (the "Organization"). The Care Management Assistant implements patient discharge plans, assists with coordination of clinical utilization review, and makes third party payer notifications in support of nursing and social work staff on the case management team. The Case Management Assistant also interacts with representatives from insurance companies, health maintenance organizations, home care agencies, skilled nursing facilities, durable medical equipment companies, and transportation agencies. Collects and audits patient outcome data, prepares reports for utilization reviews. Documents activities and progress in medical charts and computer billing/utilization systems. Inputs clinical information into database systems. Prepares Medical Appeal paperwork. The Care Management Assistant displays and practices a work-style reflecting the mission, vision and values of the Care Management team, as well as the Organization. Participates in the continuous quality improvement process. Maintains a working knowledge of departmental standard operating procedures, including the use of specialized instrumentation, Quality Control requirements, and preventive maintenance. Education and Experience One (1) year acute care, home health or skilled nursing facility experience required. Two years of college-level education in healthcare or related field preferred Working knowledge of Microsoft Office Suite, including Outlook, Word, Excel, and PowerPoint, plus healthcare database systems preferred Bachelor's degree in healthcare-related field preferred Three (3) years administrative experience working in a healthcare environment preferred License Preferred Licensed Clinical Social Worker (LCSW) in good standing with the State of California