Clinical Support Associate, Nemt

Pay Range: $20.88 - $30.27

Job Summary

A Clinical Support Associate - non-emergency medical transportation (CSA NEWT) is assigned to Utilization Management, Behavioral Health and Pediatric-Whole Child Model program. The CSA reports to the unit manager or their designee. The CSA is responsible for providing coordination support for the clinical teams, supporting the daily operational functions, facilitating timely work processes, and performing clerical activities of the assigned unit. The CSA must have strong and clear written and verbal communication skills. The CSA is responsible for accurate and timely data entry and data collection. The CSA interacts with other CenCal Health employees, providers, and members. Depending on unit assignment and as overseen by the manager or their designee, a CSA may be responsible for processing authorization and referral requests, completing health surveys with members, and/or following selected members that need periodic telephonic outreach calls.

Duties and Responsibilities

This position receives day-to-day supervision by the unit manager or their designee and include, but are not limited to, the following task for the specified unit:

General CSA Duties and Responsibilities:
Timely answering of inbound calls in the Health Services phone queues
Make outbound calls to providers, members, and CenCal Health staff regarding operational processes
Timely communication of conflicts or difficulties with members or providers to the immediate supervisor
Maintain confidentiality and privacy of member information in adherence to HIPAA and Confidentiality laws and regulations
Adhere to CenCal Healths mission, protocols, policies and procedures and meet required performance standards
Timely attendance of Company-wide and department meetings and trainings and, as appropriate, actively participate
Respond to emails, telephone calls, and other modes of communication promptly, professionally and courteously
Interact with CenCal Health employees, members, and providers professionally
Answer inbound calls from unit phone queue and make outbound calls to providers and members regarding authorization request status
Accurately enter authorization requests and submitted documents into the authorization system
Obtain all necessary documentation required to process referrals and requests for covered services
Respond to inquiries regarding the authorization processes and request statuses from providers, members and staff from other departments
Act as a liaison between clinical reviewers and providers/members
Accurately enter billing and diagnosis codes, category and type of service, amount, frequency, and/or volume of requested or approved services and procedures
Process authorization requests within established timeliness standards
Track and monitor timeliness of service authorization and referral requests
Accurately prepare, edit and finalize written determination notices to providers and members
Prepare timely and accurately formatted notices and retain/store documents related to authorization request and determination notices
Verify eligibility and/or other payor source
Collaborate and communicate with other Health Plan departments such as, but not limited to, Member Services, Providers Services and Claims
Inform members and providers of the authorization and appeal processes
Adhere to authorization timelines of Federal and State agencies that govern health plan operations
As directed, process long term care recertification
As directed, process inpatient authorization request
Process limited authorization request according to written guidelines
Work closely with the clinical team, which includes physicians, nurses, and social workers
Make phone contacts to members
As assigned, telephonically screen the members well-being and/or make contact to their family or authorized representative
As assigned by the clinician, perform tasks identified in a member-centered care plan to meet or progress toward established goals or outcomes
As assigned, follow members who are in the lowest level of case management or care coordination services
Promptly communicate any changes in a member status to the assigned clinician
Organize, schedule, track and monitor member contacts
Submit accurate reports and complete documentation in a timely manner
Perform timely outreach calls to members
Assist members with completing health surveys
Generate and mail post-program satisfaction survey; and as necessary, perform outreach calls
Adhere to department protocols and procedures for electronic data entry and form completion
As requested, participate in the case conference and care plan development
Provide members with community and referral resources that may benefit their ability to self-manage their condition and/or maintain their independence
Work collaboratively with the clinical team to monitor the members adherence to their established care plan

Skills/Knowledge/Abilities

Required:
Ability to work independently and follow directions with minimal supervision and as an active participant of an interdisciplinary team
Ability to utilize constructive feedback as a learning and growth opportunity
Demonstrate excellent organizational and multi-tasking skills
Understand basic medical terminology, billing (CPT) and diagnoses (ICD-10) coding
Maintain member confidentiality and HIPAA compliance
Must be detail-oriented and maintain clear and accurate records
Complete assigned duties while adhering to regulatory timelines
Must be able to type at a minimum of 35 wpm
Work effectively with people with varying backgrounds and educational levels
Prepare grammatically correct, clear and concise correspondence

Preferred:
Basic knowledge of Medi-Cal and its covered services
Knowledge of health-related community-based organizations, health care delivery systems, and resources for the low income and elderly population
As designated, bilingual in Spanish (not required for Utilization Management positions)

Education and Experience

Required:
High school diploma or GED
Associates degree in business, health science, healthcare, health management or related field OR three (3) years of experience as a Certified Medical Assistant, Certified Nursing Assistant or Licensed Vocational/Practical Nurse may substitute for an Associate Degree
Twelve (12) months of full-time, or its equivalent, experience in a medical office, health plan, managed care organization, hospital (ED or inpatient), skilled nursing facility, clinic or other healthcare setting working directly with patients, members, providers and/or other clinicians

• Successful completion of one of the following accredited education programs: Medical Assistant or Medical Office Professional. Successful completion can substitute for six (6) months of work experience

Preferred:
Bachelors degree in one of the above fields
Two (2) years of full-time, or its equivalent, of clinical experience in an outpatient or ED clinic, health plan, managed care or medical office setting