Utilization Management Assistant | Case Management | PRN Varied Shifts

Overview

The Case Manager Assistant under the direct supervision of the Registered Nurse Case Manager will perform clerical duties to include but not be limited to: issuance of regulatory letters, monitoring of Sfax for authorizations and denials, transference of Medicare primary insurance information to ACM, obtaining insurance authorizations telephonically, answering incoming calls to the department.

The Case Manager Assistant under the direct supervision of the Registered Nurse Case Manager will perform clerical duties to include but not be limited to: issuance of regulatory letters, monitoring of Sfax for authorizations and denials, transference of Medicare primary insurance information to ACM, obtaining insurance authorizations telephonically, answering incoming calls to the department.

• Issue regulatory letters to include:
  Discharge Important Message from Medicare, MOON, and HOON with documentation of such in AllScripts. Notify RN Case Manager if further explanation to the patient is needed.
• Monitor Sfax for insurance authorizations. Transfer fax to the appropriate RN Case Manager’s Sfax folder.
• Monitor Sfax for insurance denials. Transfer fax to the appropriate RN Case Manager’s Sfax folder and notify that RN Case Manager of the denial verbally or telephonically.
• Transfer PFM Medicare eligibility note from PFM to ACM
• Verify initial Important Message from Medicare, HOON, or MOON are properly scanned into SCM and document such in the ACM note.
• Obtain current and retrospective insurance authorizations telephonically and notify the appropriate RN Case Manager
• Answer incoming calls to the department. Transfer calls to the appropriate RN Case Manager’s or Care Coordinator’s phone.
• All other duties as assigned by department

High School Diploma or equivalent is required.

• 0-1 Medical Office/Clerical

• Basic Medical Knowledge
• Basic Computer Knowledge (MS Suite – Word, Excel, etc…)