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Experience:
1-3 years of experience
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Employment Type:
Full time
Posted:
7/23/2015
Job Category:
Administration
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Case Management/Disease Management Assistant II (CA: Woodland Hills)
Health Net, Inc. | Woodland Hills, California
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Job Description

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Job Summary

The Case Management/Disease Management (CM/DM) Assistant II is responsible for providing general administrative support and assistance to the nurses in the CM/DM department. This position is also responsible for assisting Health Net's medical management team with identifying members appropriate for case management and/or disease management programs/services.

Essential Duties & Responsibilities

 

  • Demonstrates regular, reliable and predictable attendance.
  • Compiles and/or completes documentation and correspondence reflecting activities, ensuring accuracy, completeness and conformance to standards.
  • Documents all activities and enters information into the system.
  • Provides information to licensed health professional for review.
  • Assists in preparing documentation for presentation to nurse and/or medical director for review.
  • Assists in the triage process and prioritization of cases to meet required turnaround times.
  • Expedites access to appropriate care for members with urgent or immediate needs using expedited review process.
  • Identifies and refers potential quality of care concerns.  Identifies and refers members who meet disease management or case management referral or screening triggers or guidelines.  Identifies potential TPL/COB cases, investigates TPL/COB issues and notifies the appropriate internal departments.
  • Works collaboratively with other Health Net departments to research and resolve issues.
  • Supports the operational activities of the CM/DM department.
  • Performs administrative and clerical support duties.
  • Attends administrative and clinical meetings.
  • Performs special audits, projects and other duties as assigned.

Education

  • High school diploma
  • Certification/Licensure Required

    Government Clearance & US Citizenship Requirement

    N/A

    Experience Required

  • One to two years of experience in one or more of the following: utilization review, case management, or prior authorization, preferably in a managed care setting
  • Knowledge, Skills & Abilities

  • Working knowledge of medical terminology, ICD-9 and CPT-4 coding, and disease categories and services provided in an ambulatory and institutional setting desired
  • Proficient and accurate keyboarding skills
  • Windows-based PC skills
  • Ability to interact professionally
  • Strong team player
  • Customer service and interpersonal skills
  • Verbal and written communication skills
  • Analytical and problem-solving skills
  • Working Conditions

  • The following section describes the general physical requirements for this position. Please note that refers to more than 81% of time; refers to 40-80%; and refers to 20-40% of the time.
  • Operates personal computers, printers, facsimile, telephones, copy machines and other commonly used office accessories/equipment.
  • Exposed to confidential information and expected to maintain confidentiality at all times; must adhere to HIPAA rules and regulations.
  • May be required to work outside of normally scheduled hours as mandated by the client, project and/or workload (e.g. evenings, weekends, and/or holidays).
  • May be required to maintain established work pace, meet deadlines; may have last minute urgent requests.
  • Physical activity may include: twisting, reaching, kneeling, bending, stooping, squatting, crawling, grasping, grabbing, pushing, pulling, repetitive motion, climbing, etc.
  • Required to have visual acuity to determine the accuracy, neatness, and thoroughness of the work assigned.
  • Required to have hearing ability to receive detailed information through oral communication.
  • Required to have speaking ability to express or exchange ideas.
  • Constant concentration may be required on various subjects by listening, reading and thinking clearly.
  • Interaction with others may be required. May need to listen, think, and speak in order to interact with others. Business interactions and behavior between coworkers and/or external customers are required. This may require face-to-face or telephone interactions.
  • Thinking at work may include listening, learning, analyzing, evaluating, and the ability to interpret what is seen and/or heard, or to link information from one issue to the next.
  • Constant computer usage including typing and/or eye strain.
  • Significant repetitive arm, wrist, hand and finger motions -- making repetitive movements (e.g. key boarding, filing, data entry).
  • Significant phone usage; headsets may be required.
  • Constant sedentary work (desk bound or seated).
  • Constant reading is required via computer screen and/or bound printed materials.
  • OR
  • Any combination of academic education, professional training or work experience, which demonstrates the ability to perform the duties of the position.
  • Disclaimer

    DISCLAIMER: The above statements are intended to describe the general nature and level of work being performed by individuals assigned to this job. They are not intended to be construed as an exhaustive list of responsibilities, duties and skills required of personnel so classified.

    Location:

     

    Health Net, Inc. supports a drug-free work environment and requires pre-employment background and drug screening.

    Health Net and its subsidiaries are an Equal Opportunity/Affirmative Action Employer - Minorities/Females/Veterans/Disability

     

     

    About Health Net, Inc.

    Health Net, Inc. (Health Net) is an integrated managed care organization that delivers managed healthcare services through health plans and government-sponsored, managed-care plans. The Company operates and conducts its businesses through its subsidiaries. Health Net's health plans and government contracts subsidiaries provide health benefits through its health maintenance organizations (HMOs), insured preferred provider organizations (PPOs) and point-of-service (POS) plans to approximately 6.7 million individuals across the country through group, individual, Medicare, (including the Medicare prescription drug benefit commonly referred to as Part D), Medicaid, TRICARE and Veterans Affairs programs. The Company operates within two segments: Health Plan Services and Government Contracts. (Source: 10-K)

    This company profile was created by AfterCollege and is about Health Net, Inc.. This page is not endorsed by or affiliated with Health Net, Inc.. For questions regarding company profiles, please email: care@aftercollege.com.