Case Manager

2 days ago

Fleming Island, United States Palms Medical Group Full time

We hire to retire. Come join our amazing team of professionals offering total family wellness and healthcare to residents of 7 counties via our 13 offices in North Florida. This position is Monday - Friday: 8:00am - 5:00pm.

PERKS:

  • Enjoy 12 PAID Holidays including your Birthday.
  • Family focused company values for work/life balance
  • 20 days of PTO per year.
  • Pay increase after initial 90 days of employment,
  • Low-cost Palms office visits and Palms Pharmacy prescriptions for employees and dependents.
Position Summary
  • The Case Manager is responsible for providing first class customer service and ensures that all necessary patient referral data is completed and coordinated properly, accurately and thoroughly.
Description of Primary Responsibilities

  1. Responsible for customer service
  2. Provide necessary customer and support services to patients of Palms Medical Group within his/her field of training in accordance with stated policies and procedures of PMG.
  3. Answer, screen and route telephone calls in a polite and professional manner.
  4. Answer the telephone within three (3) rings.
  5. Know how to efficiently operate a multiline telephone (transferring, voicemail and que).
  6. Document phones calls in EHR.
  7. Know all PMG departments and services.
  8. Responsible for referral processing
  9. Follows current and standardized referral policies and workflows
  10. Prioritizes referrals by urgency and addresses them in a by established goals.
  11. Ensures complete demographic, insurance information and appropriate clinical information is sent to referral specialists
  12. Review details and expectations about the referral with both ordering provider and patients. Explain the referral process to the patient including the steps involved, who the referral providers are and how to contact a hospital or referral specialist office.
  13. Ensure all necessary consents are available or make arrangements to obtain them.
  14. Process all incoming and outgoing patient data to ensure appropriate coordination and continuity of patient care
  15. Identify and utilize community resources. Establish relationships with services providers and personnel.
  16. Serve as point of contact for patients and specialist for questions. Assists in problem solving potential issues related to their referral due to language or social barriers.
  17. Responsible for referral tracking
  18. Follow EHR protocols for referral tracking.
  19. Retrieve reports placed in the electronic referral folder.
  20. Record all reports received.
  21. Follow PMG policies/procedures when closing out referrals.
  22. Receive and process referrals within stated timeframes,
  23. Responsible for authorizations
  24. Contact insurance companies to ensure prior approval requirements are met.
  25. Present necessary medical information to prove medical necessity of services
  26. Know which insurances require authorizations and how to document those authorizations.
  27. Responsible for administrative duties
  28. Adhere to the Referrals Policy Manual, Medical Records Policy Manual and HIPAA Policy Manual
  29. Check emails at least twice daily.
  30. Maintain patient confidentiality in accordance with HIPAA regulations.
  31. Assist with audits and surveys as directed by Case Manager Coordinator
  32. Perform any other duty assigned by the Case Manager Coordinator, Executive VP of Patient Services or CEO to improve the efficiency of PMG
Requirements

Description of Primary Attributes

General Development:
  1. Must be organized, a self-starter and detailed oriented
  2. Job duties require the ability to work independently and as part of a team
  3. Expected to multitask
  4. Know referral sources in one's geographical area
Professional & Technical Knowledge:
  • Employee will have a Working Knowledge of the following office equipment:
  • Multiline Telephone
  • Copier
  • Computer
  • Email
  • Scanner
  • Fax Machine
  • Calculator
  • Employee will be expected to navigate and operate Microsoft Office suite products, including Word and Excel
Licenses & Certifications:
  1. High School Diploma or Equivalent
  2. 1-year prior experience in insurance verification and referrals


Communications Skills:

Effectively communicates complex and/or technical information to co-workers, patients and/or vendors

Physical/Mental/Emotional Demands:
  • Standing for long periods of time
  • Sitting for long periods of time
  • Viewing a computer monitor for long periods of time
  • Bending
  • Stretching / Reaching
  • Walking short distances
  • Lifting up to 50 pounds
  • Operating office equipment (computer, fax machines, telephones and copy machines)
  • Reading forms / Instructions / Patients Charts
  • Communicating well to people of various ages, educational levels, cultural backgrounds in person or by telephone
  • Exposure to potentially violent / irate patients
  • Health / Safety Consideration of Position
  • Exposure to chemical infectious / contagious illness
  • Exposure to chemical and inhalation of antibiotics during reconstitution
  • Exposure to X-Ray radiation
  • Exposure to a variety of scents and odors
  • Must utilize universal precaution in clinical or exposure situations as prescribed by federal state, and local guidelines and /or laws

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