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Case Management Assistant

Company: UnitedHealth Group
Location: Cranston
Posted on: March 18, 2020

Job Description:

POSITION DESCRIPTION

APPLECARE MEDICAL MANAGEMENT GROUP was incorporated in 2003. Over the last 17 years, the multispecialty medical group of independent practices has expanded into new communities, contracted with more hospitals and health plans, and added over 50 new doctors - but the mission has remained the same. Today, APPLECARE MEDICAL Management is comprised of hundreds of board-certified private-practice, independent physicians. Collectively, our physicians have been serving the Southeast area of Los Angeles and Northern Orange County for decades, providing their medical expertise and passion to improving the health of our communities.
The CASE MANAGEMENT ASSISTANT is responsible for the facilitation of the authorization process and assists the Clinical Services Case Managers with the Utilization and Quality Management processes. This includes the collection of clinical data and the submission of that data to licensed clinical staff for review and decision - making. The Case Management assistant may not make decisions which require clinical judgment.

PRIMARY RESPONSIBILITIES:

- Authorizes selected services per explicit criteria and guidelines
- Collects data for clinical review and submits data to licensed clinical services staff for decision-making
- Performs outbound patient calls per clinical pathway
- Facilitates patients appointments as directed by the case manager
- Manages a case load of 100 - 150 low acuity patients that are identified for population management by the case manager
- Presents cases to IDT for low risk members with case manager oversight
- Provides feedback to Clinical Services Supervisor regarding process improvement
- Performs data entry
- Prepares tracking reports
- Prepares denial letters
- Files / faxes
- Other duties as assigned

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Keywords: UnitedHealth Group, Cranston , Case Management Assistant, Executive , Cranston, Rhode Island

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