Healthcare Case Manager

7 days ago


Montebello, California, United States North American Staffing Group Full time

Job Title: Case Manager MA

Job Summary:

We are seeking an experienced Case Manager to join our team at North American Staffing Group. As a Case Manager, you will provide support to the Case Management Department and assist with case and care management. You will act as a liaison for case managers to assist with obtaining the HRA (Health Risk Assessments), gathering of pertinent healthcare information, and follow-up on specialty/ancillary services.

Responsibilities:

  • Creates, generates and maintains reports as requested or on a scheduled basis.
  • Coordinate member/patient inquiries regarding the authorization process and other issues with applicable internal/external functions.
  • Enters all requests into the referral tracking system, coordinates authorization request as directed by the Case Manager for the Case Management Department.
  • Maintains up-to-date knowledge about payer sources. Knowledgeable about the regulations regarding these various payer sources.
  • Facilitates communication with CCS authorizations, third-party payers and clinical staff to ensure authorization of services.
  • Processes all referral requests from the physicians according to department policy and procedure.
  • Coordinates and assists with patient appointments as needed and notifies patient of authorization status.
  • Obtains consultation reports from specialists and submits to provider for review.

Requirements:

  • High School diploma plus a minimum 2 years experience working in a healthcare environment; knowledge of prior authorization and case management regulations governing Medi-Cal, Commercial, Medicare, CCS, and other government and commercial programs.
  • Minimum 2 years experience in a managed health care environment, preferably IPA, HMO, or Health Plan.
  • Bilingual English/Spanish preferred.
  • Medical Billing Certification preferred.
  • Medical Assistant experience strongly preferred.

Location: Montebello, CA


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