DHR Health - US:TX:Edinburg - Days
Summary:
POSITION SUMMARY:
The Case Manager Assistant receives and processes requests for clinical information, peer to peer activity and patient coverage updates from third party payers. Provides information to the appropriate case manager of third party payer requests in a timely manner. Updates appropriate computer systems with most recent activity in regard to these changes. Collaborates with Resource Management team to maintain smooth transition of information from clinical side to the payer side.
POSITION EDUCATION/ QUALIFICATIONS :
- High School Diploma/GED required
- Hospital experience preferred
- Office/Secretarial experience is required
- Organizational skills are necessary
JOB KNOWLEDGE/EXPERIENCE :
- Requires good communication and organizational skills.
- Requires reasoning ability and good independent judgment.
- Requires working with frequent interruptions.
- Must project a professional image.
- Working knowledge of computer and software applications.
- Must be able to revise workflow when necessary, adapting routine to departmental needs.
Responsibilities:
POSITION RESPONSIBILITES:
- Performs daily review of necessary reports to ascertain required activity on specific payer accounts. Maintains accurate record of activity on a daily basis.
- Establishes, maintains and revises record keeping and filing systems, ensuring confidentiality of information.
- Communicates with case managers any requests from payers for additional information, initial clinical review, peer to peer opportunities, and any denials for patients currently in-house.
- Communicates with Director regarding any potential issues with coverage.
- Coordinates (communicated need for) continued stay reviews when requested by payers with UR Nurses and Case Managers.
- Maintains accurate documentation on computer system as applicable.
- Accepts and screens telephone calls and routes calls appropriately; promptly and graciously responds to calls and determines the urgency of the situation; suggests appropriate referrals or informs Director when the situation warrants immediate attention.
- Tactfully handles difficult situation; contacts are handled professionally and consistently with courtesy.
- Established good rapport and cooperative working relationships with the Resource Management Team and hospital personnel.
- Performs well under pressure.
- Other duties as assigned
Other information:
LINES OF REPSONSIBILITES :
(Chain-of-command)
1. Resource Management
CUSTOMER SERVICE:
Provide excellent customer service to all DHR customers. All employees are required to attend the DHR C.A.R.E.S program which outlines the Customer Service Principals including: Commitment, Accountability, Respect, Excellence and Service.
AGE SPECIFIC :
Employees must be able to demonstrate the knowledge and skills necessary to provide care appropriate to the age of the patients served in his/her assigned unit. The individual must demonstrate knowledge of principles of growth and development over the life span and possess the ability to assess data reflective of the patient’s status and interpret the appropriate information needed to identify each patient’s requirement relative to his or her age.
AMERICANS WITH DISABILITIES ACT: (ADA) :
A. Essential Duties : Indicated by bold print within performance standards, preceding individual numbered criteria.
The following table provides physical requirements that will be associated with, but not limited to, this position:
- Light/moderate lifting up to 20 lbs, from the floor to shoulder height.
- Must be able to assist other employees with lifting more than 20 lbs.
- Light/moderate carrying up to 20 lbs.
- Dual simultaneous grasping
- Operating office equipment
- Operating mechanical equipment
- Ability to read and write
- Ability to hear verbal communication without aid
- Operating Personal Vehicle
- Ability to comprehend written/verbal communication
- Other: Ability to deal with stress
B. Working Conditions : The individual spends over 95% of his/her time in an air-conditioned environment with varying exposures to noise. There is protection from weather conditions but not necessarily from temperature changes. The position does have low exposure to malodorous, infectious body fluids from patients and some minimal exposure to noxious smells from cleansing agents.
C. Occupational Exposure: This position has minimal to no exposure to blood, body fluids, or tissues and is an OSHA Category III (although situations can be imagined or hypothesized under which anyone, anywhere, might encounter potential exposure to body fluids). Person who performs these duties are not called upon as part of their employment to perform or assist in emergency medical care or first aid or to be potentially exposed in some other way.
D. Aptitudes : HIGH 1 2 3 4 5 6 LOW
Intelligence: General learning ability: The ability to “catch on” or understand instructions and underlying principles. Ability to reason and make judgments. 3
Verbal: Ability to understand meanings of words and ideas associated with them, and to use them effectively. To comprehend language, to understand relationships between words, and to understand meanings of whole sentences and paragraphs. To present information or ideas clearly. 3
Numerical: Ability to perform arithmetic operations quickly and accurately. 2
Spatial: Ability to comprehend forms in space and understands relationships of plane and solid objects. Frequently described as the ability to “visualize” objects or two or three dimensions, or to think visually of geometric forms. 2
Form Perception: Ability to perceive pertinent details and objects or in pictorial or graphic material to make visual comparisons and discriminations and see slight differences in shapes and shadings of figures and widths and lengths of lines. 3
Clerical Perception: Ability to receive pertinent details and verbal or tabular material. To observe differences in copy, to proofread words and numbers, and to avoid perceptual errors in arithmetic computation. 2
Motor Coordination: Ability to coordinate eyes and hands to fingers rapidly and accurately in making precise movements with speed. Ability to make a movement response accurately and quickly. 3
Finger Dexterity: Ability to move hands easily and skillfully. To work with fingers in placing and turning motions. 3
Manual Dexterity: Ability to move hands easily and skillfully. To work with hands in placing and turning motions. 3
Eye-Hand-Foot Coordination: Ability to move the hand and foot coordinately with each other in accordance with visual stimuli. 3
Color Discrimination: Ability to perceive and respond to similarities or differences in colors, shapes, or other values of the same or different color. To identify a particular color, or to recognize harmonious or contrasting color combinations, or to match color adequately. 3
I have read and reviewed my job description with my supervisor or designee and I understand the job I am expected to perform.
If applicable ____________ certification will be completed within _________ time frame of hire/transfer date.
Employee Signature: ________________________________ Date: ____________________
Transfer/Hire Date Effective: ________________________.
