1. Assists Outpatient Case Manager(s) with arranging services for members, such has home health, DME, physician appointments, specialist appointments, and transportation.

2. Follows up with patients to ensure arranged services are received.

3. Maintains turnaround time compliance in all aspects of the case management Standards of Operation.

4. Keeps patient and/or family members or other customers informed of care coordination.

5. Assists other staff and supports the team approach.

6. Demonstrates the ability to follow through with requests, sharing of critical information, and getting back to individuals in a timely manner.

7. Demonstrates honesty and integrity in everyday activities.

8. Protects privacy for both patients and employees; ensuring all personal health information is kept confidential i.e., (sensitive papers, charts, and reports are not in view of the public).

9. Recognizes when an error has been made and immediately reports to appropriate manager.

10. Participates in “service recovery” through follow-up with an upset member, gathering information, and demonstrating empathy.

11. Treats members and their families with respect and dignity. 

12. Functions as liaison between administration, members, physicians, and other healthcare providers.

13. Interacts professionally with other healthcare service providers.

14. Communicates appropriately and clearly to management, co-workers, and physicians.

15. Consults other departments as appropriate.

16. Participates in the efficient, effective, and responsible use of resources such as supplies and equipment.

17. Maintains all reference material that is provided.

18. Knows and follows the Employee Handbook policies and procedures.

19. Must maintain a >95% benchmark in quality audits.

20. Must maintain high productivity based on membership and case load volume.

21. Maintain a low Unable to Reach/Contact & Declined rate.

22. Must assist team in case load as needed.

23. Must not have abandoned calls.

24. Timely fax server review and clearance.

25. Attend meetings timely and participate with constructive feedback.

26. Have a ‘Can Do’ attitude.

27. Be Proactive in anticipating the needs of the department.

28. Create an open communication environment by asking questions when in doubt.

29. Reporting if there are system issues that affect productivity.

30. Distribution of work: Daily production will vary from day to day. All assigned work must be completed by the end of business day in order to maintain customer service to members and turnaround time compliance.

31. Protect member’s privacy and adhere to HIPAA regulations at all times.

32. Follows company policy.

33. Remains flexible and open to process changes and updates.

34. Arrives each day fully prepared to tackle job responsibilities.

35. Remain objective.

36. Problem Solve using resources and innovative ideas.

37. Performs other duties as assigned

1. High school graduate required.

2. Minimum of 1 year of experience and knowledge of Healthcare & Managed Care.

3. Knowledge of computers, faxes, printers, and all other equipment.

4. Proficient in MS Office programs (i.e., Word, Excel, & Outlook).

5. Typing 30 WPM with accuracy.

6. Ability to deal with responsibility with confidential matters.

7. Ability to work in a multi-task, high stress environment.

8. Ability to be flexible with changes in process and procedures.

9. Critical Thinking

10. Experience with HMO, Medicare, and or Medi-Cal

11. Good phone etiquette

12. Professionalism

13. Strong analytical skills with the ability to organize, analyze, and disseminate significant amounts of information with attention to detail and accuracy.