Case Manager Jobs

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

• Responsible for referral tracking
• Process all incoming and outgoing patient data to ensure appropriate coordination and continuity of patient care
• Maintain patient confidentiality in accordance with HIPAA regulations.
• Follows current and standardized referral policies and workflows
• Assist with audits and surveys as directed by Case Manager Coordinator
• Follow EHR protocols for referral tracking.
• Responsible for customer service
• Present necessary medical information to prove medical necessity of services
• Know all PMG departments and services.
• Contact insurance companies to ensure prior approval requirements are met.
• Responsible for authorizations
• Perform any other duty assigned by the Case Manager Coordinator, Executive VP of Patient Services or CEO to improve the efficiency of PMG
• Know which insurances require authorizations and how to document those authorizations.
• Identify and utilize community resources. Establish relationships with services providers and personnel.
• Answer the telephone within three (3) rings.
• 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.
• Receive and process referrals within stated timeframes,
• Responsible for referral processing
• Answer, screen and route telephone calls in a polite and professional manner.
• Follow PMG policies/procedures when closing out referrals.
• Retrieve reports placed in the electronic referral folder.
• 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.
• Know how to efficiently operate a multiline telephone (transferring, voicemail and que).
• Prioritizes referrals by urgency and addresses them in a by established goals.
• 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.
• Ensure all necessary consents are available or make arrangements to obtain them.
• Check emails at least twice daily.
• Document phones calls in EHR.
• Adhere to the Referrals Policy Manual, Medical Records Policy Manual and HIPAA Policy Manual
• Record all reports received.
• Ensures complete demographic, insurance information and appropriate clinical information is sent to referral specialists
• Responsible for administrative duties

Description of Primary Attributes

General Development:

• Expected to multitask
• Must be organized, a self-starter and detailed oriented
• Know referral sources in one’s geographical area
• Job duties require the ability to work independently and as part of a team

Professional & Technical Knowledge:

• Multiline Telephone
• 1. Employee will have a Working Knowledge of the following office equipment:
• Copier
• Fax Machine
• Scanner
• 2. Employee will be expected to navigate and operate Microsoft Office suite products, including Word and Excel
• Computer
• Calculator
• Email

Licenses & Certifications:

• 1-year prior experience in insurance verification and referrals
• High School Diploma or Equivalent

Communications Skills:

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

Physical/Mental/Emotional Demands:

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