Case Management Assistant (PHM)- Bakersfield 1.2 Full Time

About The Position

Requirements

• High School diploma or GED required.
• Minimum of 3 years of experience in a healthcare or community health setting.
• 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 shared 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 problem-solving 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.

Nice To Haves

• Knowledge of case management processes and regulatory requirements for Medi-Cal, Medicare, and commercial programs preferred.
• Experience in a managed care environment preferred (IPA, HMO, or health plan).
• Medical Assistant or Community Health Worker certification preferred.

Responsibilities

• Work collaboratively with Nurse Case Managers and Social Services staff on care coordination, member follow-up, communication with agencies.
• Support PHM outreach activities by conducting calls for program enrollment, Health Risk Assessment (HRA) completion and other relevant questionnaires, wellness checks, and quality initiatives to help close care gaps.
• Contact members at regular intervals per their acuity level and care plan needs.
• Document all outreach, coordination activities, and member interactions in the case management system (CM System) accurately and in a timely manner, in alignment with program protocols.
• Support members experiencing transitions of care by assisting case managers with coordination of post-discharge needs, follow-up appointments, and transportation.
• Gather clinical information and assist with coordinating services such as home health care, prescriptions, durable medical equipment (DME), and social service referrals.
• Prepare and send member correspondence, as directed by case managers or in alignment with case management protocols.
• Report and escalate member concerns, variances, or changes in condition to the appropriate care team members to ensure timely intervention and coordinated follow-up.
• Assist members with appointment scheduling, transportation, referral coordination, and other care coordination needs.
• Gather clinical information from outside sources such as PCPs, specialists, hospitals, SNFs, and electronic health records, and upload them into the case management system.
• Verify member eligibility, demographics, and benefits; confirm provider assignments to ensure authorizations are linked appropriately.
• Support closed-loop referrals to community supports, housing, and social service agencies, with follow-up to confirm services were delivered.
• Participate in ICT meetings by gathering and presenting information and communicating member needs and preferences to the care team.
• May be assigned to manage a caseload of low-acuity PHM members, under the supervision of Nurse Case Managers or Social Services staff.
• Serve as an associate and resource to members, providers, staff, and external customers regarding policies, benefits, and care coordination.
• Provide administrative support, including answering phones, assisting with correspondence, filing, scanning, and maintaining department data systems.
• Receive and route incoming faxes, medical records, and other documentation to the appropriate case management staff.
• Track and log outreach attempts and results in the case management system to support reporting and follow-up.
• Conduct outreach to members to verify needs are being met and services delivered.
• May be assigned to conduct in-person meetings with members during clinic visits.
• Assist with training and orientation of new staff, as requested.
• Assist case management team with oral interpretation, as applicable.
• Attend mandatory staff and departmental meetings.
• Perform other duties as assigned.

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