Dignity Health Asst Case Management in BAKERSFIELD, California
The purpose of Dignity Health Management Services Organization (Dignity Health MSO) is to build a system-wide integrated physician-centric, full-service management service organization structure. We offer a menu of management and business services that will leverage economies of scale across provider types and geographies and will lead the effort in developing Dignity Health’s Medicaid population health care management pathways. Dignity Health MSO is dedicated to providing quality managed care administrative and clinical services to medical groups, hospitals, health plans and employers with a business objective to excel in coordinating patient care in a manner that supports containing costs while continually improving quality of care and levels of service. Dignity Health MSO accomplishes this by capitalizing on industry-leading technology and integrated administrative systems powered by local human resources that put patient care first.
Dignity Health MSO offers an outstanding Total Rewards package that integrates competitive pay with a state-of-the-art, flexible Health & Welfare benefits package. Our cafeteria-style benefit program gives employees the ability to choose the benefits they want from a variety of options, including medical, dental and vision plans, for the employee and their dependents, Health Spending Account (HSA), Life Insurance and Long Term Disability. We also offer a 401k retirement plan with a generous employer-match. Other benefits include Paid Time Off and Sick Leave.
Provides support for the Clinical Services Department, including Outpatient Case Managers, Social Services team, and Health Education, specifically through the coordination of services within the DHMSO Clinical Programs and DHMSO Case Management program. Serves as intake coordinator for referrals into disease management program(s), coordinating requests for services, monitoring members, and reporting findings. Facilitates communication between providers, DHMSO staff, hospital physicians, patients and their families with regard to coordination of services.
Responsible for meeting all of the DHMSO Job Standards described below.
Contacts members who are identified as appropriate for medical management program(s). Explains process for telephonic management to members and obtains member consent to participate. Communicates via phone with members participating in the program(s). Contacts program participants at regular intervals to evaluate health status according to program protocol. Reports variances to nursing staff assigned to the patient. Confirms medications currently taken by member during each call. May communicate obtained information to PCP, Home Visit Program MD or DHMSO Clinical Programs MD as directed.
Documents all contacts pertaining to assigned members in PCM. Utilizes e-mail communication to insure that all appropriate staff are kept informed of relevant issues. Functions as a resource for access into Cerner for Case Management teams. Maintains accurate records of referrals, appointments, evaluation and management process for the Clinic and Case Management program.
Processes referral requests according to company policy. Responsible for insuring all authorizations are received by the appropriate parties. Responsible for faxing clinical information, orders and authorizations generated by the Clinic and Case Management program to providers. May also assist with appointments as directed.
Responsible for gathering clinical information from outside sources such as PCPs, specialists and other providers, hospital logs, Cerner, PCM, hospital case managers, and outpatient UM staff.Forwards information to staff for the purpose of evaluation for initiation of management as well as ongoing management by the Case Management program.
Answers telephone inquiries professionally regarding issues that pertain to referrals and care (e.g., referral status, procedures on how to request authorizations, etc.). May assist with other clerical duties, including data entry, chart preparation, report generation and appointment scheduling, ordering supplies for the departments, general support for Case Management, Social Services and Health Education.
Verifies member eligibility, demographic information, and benefits as follows:
health plan eligibility or certificate number
effective date of coverage
cancellation date if member is dis-enrolled
patient address and phone number – ensures information is up-to-date
health plan and benefit options - ensures authorization is issued to appropriate member for appropriate benefit
verifies benefits per company policy for appropriate services
Verifies member’s Primary Care Physician and the Physician Specialist provider number to ensure that authorization is requested and issued to appropriate network provider.
Determines the appropriate financial responsibility assignment when processing authorizations and that information is entered into the system correctly, by utilizing the financial responsibility matrix and the shared risk matrix correctly.
JOB KNOWLEDGE, SKILLS & ABILITIES
Knowledge and understanding of IPAs, PPOs, and HMOs with regard to benefits, policies and procedures, documentation requirements and medical terminology.
Must have strong oral and written communication skills as well as organizational and project management skills.
Computer experience required with familiarity with QNXT, MS Windows (Word and Excel), and Cerner applications preferred.
Successful completion of medical assisting program (CMA) from an approved educational facility.
At least one year experience working as a medical assistant or caregiver required.
Two or more years experience in a clerical position within medical office, insurance or other relevant setting preferred.
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Dignity Health is an Equal Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected Veteran status or any other characteristic protected by law. For more information about your EEO rights as an applicant, please
If you need a reasonable accommodation for any part of the employment process, please contact us by telephone at (415) 438-5575 and let us know the nature of your request and your contact information. Requests for accommodation will be considered on a case-by-case basis. Please note that only inquiries concerning a request for reasonable accommodation will be responded to from this telephone number.
Job ID 2018-54915
Employment Type Full Time
Department Utilization Review
Hours / Pay Period 80
Facility Dignity Health Management Services Organization
Standard Hours Mon-Fri (8-5 PM)