Case Management Assistant, Utilization Management - Full-Time/Days
MemorialCare Health System
Location: Fountain Valley, California
Internal Number: MEM006445
The Inpatient Case Management Assistant is responsible for supporting the Inpatient Nurse Case Managers in the discharge needs of our hospitalized members. They coordinate with various institutions, vendors, home health agencies and personnel to process member's requests and perform administrative duties under the Inpatient Nurse Case Manager’s direction. They also submit logs, documents, write reports, verify referral information, and monitor post discharge follow-up care. Case Management Assistants must have excellent communication and organizationalskills, especially in interacting with people in determining immediate solutions.
Essential Functions and Responsibilities of the Job
Assists with the completion of the admission/discharge log that is sent to the primary health plan
Collaborates with nurse case managers regarding transitional care planning and post discharge follow-up
Submits referrals to Complex Case Management if member meets criteria
Assists member with the scheduling of medical and diagnostic appointments with the clinics as needed
Refines essential intervention skills including active listening, therapeutic communication and the ability
to interact with a broad variety of people
Conducts follow-up phone calls to members to document compliance with authorized services, like Home
Health and DME delivery. Reports variance of discharge plan to the nurse case manager.
Reinforces discharge education provided to the member/family/caregiver and identifies potential
problems that may lead to an ED visit or readmission
Documents clearly and concisely in the case management electronic record, Compass Rose.
Obtains CCS referral information and hard copies of the CCS determination from the outside hospitals and
attaches those to the media section in Epic. This information that is not accessible to us in PEDI.
Assists with the finalizing of the California Children’s Services (CCS) admission and bed days in the CCS
Provider Electronic Data interchange (PEDI) Closes out cases upon after discharge.
Conducts follow-up calls to families who are new to CCS and makes sure they get the CCS application
paperwork completed and sent in. Answers any questions regarding the application process.
Essential Job Outcomes
Must be able to work independently, but also in a team structure
Ability to handle telephone calls in a professional manner
Ability to maintain the discharge planning case files in Compass Rose
Ensures compliance with all health plan required post discharge activities
Can be called upon to gather discharge case files for health plan audits