Job Description
Department(s): Case Management
Reports to: Supervisor, Case Management
FLSA status: Non-Exempt
Salary Grade: C - $19.7115 - $25.4808 ($41,000 - $53,000)

Job Summary

The Medical Authorization Assistant (Case Management) is responsible for office and case management support services. The incumbent serves as a contact between members, physicians, providers and CalOptima staff to gather information, and serves as interpreter when applicable. The incumbent is responsible for providing effective, efficient, professional, and courteous interaction with providers, members/family and other CalOptima staff. Performs medical administrative and/or routine tasks specific to the assigned program and may perform office support functions.




Position Responsibilities:

• Receives cases via fax, phone, or electronic methods, and enters the new case information into the Facets and Guiding Care systems.
• Conducts individual interviews/assessments with CalOptima members and/or providers to obtain intake information.
• Obtains information on requested services according to CalOptima Health Services Department guidelines, performs data entry into Facets and Guiding Care, verifies eligibility and contacts health networks and/or CalOptima's customer service regarding health network enrollments.
• Assists the case managers in gathering medical records, obtains appropriate information on diagnosis and procedures, and follows-up on phone calls as directed by the Medical Case Managers or Gerontology Resource Coordinator.
• Documents all contacts and case information in the appropriate Facets and Guiding Care scripts or activity as appropriate.
• Performs data entry into the appropriate databases for monitoring and tracking, and trending of cases.
• Generates monthly and other required reports from the databases as requested by the Medical Case Manager and/or health networks.
• Provides customer service to providers and members.
• Processes Member Health Information Forms (HIFMETS)
• Assists with directing incoming clinical mail to the appropriate staff
• Assists teleworking staff with mailing hardcopy clinical letters and resources
• Other duties or projects as assigned.

Possesses the Ability To:

• Communicate effectively in writing and verbal with diverse audiences.
• Develop and maintain effective working relationships with all levels of staff, other programs' staff, community agencies, providers and members.
• Effectively utilize computer and appropriate software (e.g. Microsoft Office Programs: Outlook, Excel, and Word).
• Utilize prior authorization protocols to determine when to refer matters to a licensed staff.

Experience & Education:

• High school graduate or equivalent required.
• 2 years of related healthcare experience required.

Knowledge of:

• Medical terminology required.
• Medi-Cal benefits and regulations.

CalOptima is an equal employment opportunity employer and makes all employment decisions on the basis of merit. CalOptima wants to have qualified employees in every job position. CalOptima prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics.

If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability. You can request reasonable accommodations by contacting Human Resources Disability Management at 657-900-1134.

Job Location: Orange, California
Position Type:

To apply, visit https://jobs.silkroad.com/CalOptima/Careers/jobs/3668
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