Case Management Assistant, TCS (ECM)- Fresno 1.1

Location: Fresno, CA. (Onsite)

Classification: Full-Time

This position is non-exempt and will be paid on an hourly basis.

Schedule:

Monday- Universal Healthcare MSO's standard operating hours are Monday through Friday, from 8:00 a.m. to 5:00 p.m. Pacific Time. Unless otherwise specified, all employees are expected to work their assigned schedules and remain available during these operational hours.

Benefits:

· Medical

· Dental

· Vision

· Paid Time Off (PTO)

· Floating Holiday

· Simple IRA Plan with a 3% Employer Contribution

· Employer Paid Life Insurance

· Employee Assistance Program

Compensation: The initial pay range for this position upon commencement of employment is projected to fall between $21.31 and $26.63. However, the offered base pay may be subject to adjustments based on various individualized factors, such as the candidate's relevant knowledge, skills, and experience. We believe that exceptional talent deserves exceptional rewards. As a committed and forward-thinking organization, we offer competitive compensation packages designed to attract and retain top candidates like you.

Position Summary:

The Case Management Assistant- Transitional Care Services (TCS) provides support for the Case Management Department, including the Nurse Case Managers and Social Services team specifically through the coordination of services within the Enhanced Care Management (ECM) Program specific to transitional care services. The Case Management Assistant will provide support by assisting in managing members who are undergoing transitions from various care settings, including ER visits, acute care admissions, post-acute care admissions, incarcerations, and other ECM-recognized transitional care settings. The Case Management Assistant TCS will assist in enhanced care coordination activities, monitor members, report findings, and gather clinical information from outside sources. The ECM Program addresses the clinical and non clinical needs of members with the most complex medical and social needs through systematic coordination of services and comprehensive care management. ECM is intended to service those with chronic health conditions, are homeless or at-risk, with high hospital admissions, substance abuse, and/or behavioral health needs. This position requires strong interpersonal and organizational skills to build rapport with members, coordinate referrals, and care amongst various healthcare providers and community services. The Case Management Assistant TCS also collaborates with the member’s inter-disciplinary team (ICT) supporting the member, while engaging the member and their support systems to define priorities that are central to the member’s desired needs and goals.

Job Duties and Responsibilities:

• Works collaboratively and assists the Clinical or Social Services Case Manager to manage members in need of Transitional Care Services.

• Gather clinical information and assists with coordinating post-discharge services, including scheduling provider appointments, ensuring post-discharge referrals are

received by the member, transportation to appointments is arranged, and members are aware of follow-care needs.

• Proactively initiates care transition coordination with referral sources and internal partners to ensure seamless patient transitions to home or ATS. Participates with any data collection required for therapy start and patient tracking process. This may include

facilitating the transfer of orders via phone, fax, and e-prescribing.

• Effectively manage low acuity member cases within the ECM Program.

• Contacts members at regular intervals per their acuity level and care plan needs.

• Completes member questionnaires or assessments, and consistently document care management activities and encounters in the CM System, per program protocol.

• Works collaboratively and assists clinical and social services Case Managers with care coordination, member follow-up, communication with appropriate agencies and preparation and distribution of documents and/or reports.

• Reports variances and issues to nursing or social services staff assigned to the member.

• Assists members with appointment scheduling, transportation, referral coordination, and other enhanced care coordination services.

• Gathers clinical information from outside sources such as PCPs, specialists and other providers, electronic health records, and other partnering entities.

• Verifies member eligibility, demographic information, and benefits.

• Verifies member's Primary Care Physician and the Physician Specialist to ensure that authorization is requested and issued to appropriate network provider.

• Assists in maintaining the integrity of the data systems by entering information into department’s data systems.

• Provides general Office administration duties including answering phones. Provides general customer service to all potential and exiting ECM members and partnering agencies.

• Gathers relevant information for the identified member population during assessment, care planning, interdisciplinary care team meetings, and transitions of care.

• Outreaches to members to verify that needs are being met and services are being delivered.

• Intervenes at the member level to coordinate the delivery of direct services to the member and their families.

• Serves as an associate and resource to members, providers, staff, and external customers regarding policies, benefits, and care coordination.

• Assists with system letters, requests for information and data entry.

• Gather information, present, and participate in Interdisciplinary Care Team (ICT) meetings, and communicate the member’s needs and preferences in a timely manner to the member’s multi-disciplinary care team.

• Attend mandatory departmental and staff meetings.

• Assist with training and orientation of new staff.

• May be assigned to conduct in-person meetings with members during clinic visits.

Requirements

Qualifications

• Education: Education: High School diploma or GED required.

• Minimum of 3 years of experience working in a health care or community health setting.

• Advanced knowledge of prior authorization or case management regulations governing Medi-Cal, Commercial, Medicare, CCS, and other government and commercial programs.

• Experience in a managed health care environment preferred (IPA, HMO, or Health Plan).

• Medical Assistant or Community Health Worker certification preferred.

• Demonstrated experience working with one or more of the ECM populations of focus, including but not limited to: adults and children experiencing homelessness, those with serious mental illness (SMI) or substance use disorders (SUD), high-utilizers of

healthcare services, adults or children with complex physical, behavioral, or developmental conditions, individuals transitioning from incarceration, children/youth involved in child welfare, or those belonging to the birth equity population.

Knowledge and Skills

• Ability to respect the needs of members, support givers, team members, and others, and

provide excellent customer service.

• Willingness to collaborate as part of a team with professionals at all levels to achieve

goals and remove barriers to member health.

• Sensitivity to members' social, cultural, language, physical, and financial differences.

• Ability to work with members and influence behavior through negotiation of care goals

and support of member self-management.

• Strong critical thinking skills and ability to identify issues and propose solutions.

• Ability to prioritize tasks based on changes in member situations and needs.

• Ability to work independently, organize and prioritize multiple tasks throughout the day.

• Strong attention to detail and ability to be accurate, thorough, and persistent in problem

solving and task completion.

• Excellent verbal and written communication skills, with the ability to communicate

effectively with all levels of the organization and members.

• Proficiency in creating professional documents with proper grammar and punctuation.

• Ability to maintain professionalism and adapt to a changing environment.

• Ability to understand and communicate complex health and benefit information.

• Proficient in the use of common office technology, including electronic Case

Management systems.

• Reliable in attendance and adherence to work schedule and business dress code.

• Ability to always maintain strict confidentiality.

Other Requirements:

• Possession of valid driver’s license

• Proof of state-required auto liability insurance.

• Reliable transportation is required to perform essential duties, including traveling to locate and engage with members in the field or at various locations as needed.

Working Conditions:

• This position may be subject to tuberculosis (TB) testing requirements based on job duties and work location. Employees whose roles involve regular contact with members will be required to provide proof of a current negative TB test prior to hire and

periodically thereafter, in accordance with organizational policy and applicable public health regulations.

Physical Requirements & Working Conditions

Reasonable accommodations may be made to enable qualified individuals with disabilities to perform the essential functions of this position.

This position is primarily performed in a professional office environment and requires the ability to:

Mobility & Physical Activities

• Occasionally sit, stand, and walk throughout the workday.
• Occasionally climb, bend, twist, reach, push, pull, squat, kneel, crawl, and carry work-related materials.
• Occasionally perform repetitive hand and wrist movements, including keyboarding, fine motor tasks, and operating standard office equipment.
• Occasionally communicate verbally and hear conversations in person and by telephone.
• Lifting Requirements
• Occasionally lift up to 15 pounds from floor to waist level.
• Occasionally lift up to 10 pounds at or above waist level.
• Vision & Hearing Requirements

The employee must possess the ability to:

• Read printed materials and electronic documents using near and distance vision.
• Distinguish colors when necessary to perform assigned duties.
• Demonstrate adequate depth perception.
• Hear and communicate effectively in person, by telephone, and through virtual communication platforms.

Work Environment

This position is performed in a professional office environment. Under normal working conditions, exposure to the following environmental conditions is not anticipated:

• Bloodborne pathogens
• Chemicals
• Airborne communicable diseases
• Dust or particulate matter
• Uneven walking surfaces or elevations
• Extreme temperatures
• Elevated noise levels
• Radiation (where applicable)