Local 1014, the self-funded ERISA Trust dedicated to serving the well-being of the Los Angeles County Fire Fighters and their families, is seeking a Case Management Assistant II to support the work and all functions of the Utilization Management (UM) department. This position is, in many cases, the first line of contact with members and providers. The position is on-site in El Monte, CA. Position Overview The Case Management Assistant II facilitates Utilization Management correspondence, coordinates case management and discharge planning documentation, and supports third-party liability (TPL) and Workers' Compensation case files, working closely with the Patient Care Coordinator, UM Manager, and claims and bookkeeping departments. Essential Job Functions Facilitate Utilization Management correspondence to members, treating MDs, vendor facilities and organizations, the Physician Advisory Panel, carve-out-benefit management plans, consultants, and others. Type standard letters and distribute correspondence, including mailing, faxing, and emailing. Coordinate incoming correspondence. Prepare information packets related to various benefits, therapies, liens, and court hearings. Assist the Patient Care Coordinator in updating the status of case management/discharge planning cases. Maintain utilization review/case management files according to applicable retention and confidentiality requirements. Coordinate Physician Advisory review documentation and documentation for Trustee review. Update UM statistical reports as necessary, utilizing the BASYS system, UM Department information logs, MV Query, and other applicable resources. Maintain files and documentation related to third-party liability (TPL) cases and Workers' Compensation cases, including coordination with the claims and bookkeeping departments, attorneys, insurance providers, the Workers' Compensation Appeals Board, and others regarding notification documentation, subsequent letters, reports, liens, reimbursements, and computer/paper file updates, including maintenance of historical files per applicable retention and confidentiality requirements. Perform other duties as requested by the UM Manager and/or Administrative Manager/Office Manager/Trustees. Will not be allowed or required to make any decision related to determination of medical necessity. Required Knowledge/Skills/Abilities/Experience Minimum 3 years, preferred 5 years, of experience in a medical setting and minimum 3 years in an insurance setting. Knowledge of medical terminology. Proficient keyboard skills. Knowledge of Word, Excel, and Outlook. Strong interpersonal communication skills, including dispute/conflict de-escalation skills. Working knowledge of California Workers' Compensation and TPL cases preferred.

Compensation & Total Rewards Salary:

$27.5 - $29.58/hour 100% covered benefits for employee and dependents Local 1014 contributes 7%-9% of annual income toward retrirement 2 weeks accrued vacation, 10 sick days 13 holidays Office Hours Mon-Fri, 8:30 AM-4:30 PM Non-Exempt Equal Employment Opportunity Statement Local 1014 is an equal opportunity employer. We are committed to providing equal employment opportunities to all employees and applicants without regard to race, color, religion, sex, sexual orientation, gender identity or expression, national origin, age, disability, genetic information, marital status, veteran status, or any other characteristic protected by applicable federal, state, or local law. This commitment applies to all aspects of employment, including recruitment, hiring, training, promotion, compensation, and termination.

Pay:

$27.50 - $29.50 per hour Expected hours: 35.0 - 40.0 per week

Benefits:

401(k) 401(k) matching Dental insurance Employee assistance program Health insurance Paid time off Vision insurance Application Question(s): How many years of experience do you have working directly for a Health Plan or an MSO?

Experience:

Healthcare :

5 years (Preferred)

Utilzation Management:

3 years (Preferred)

Basys System:

1 year (Preferred)

Pharmacy:

3 years (Preferred)

Work Location:

In person