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.
High school diploma
Government Clearance & US Citizenship Requirement
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 desiredProficient and accurate keyboarding skillsWindows-based PC skillsAbility to interact professionallyStrong team playerCustomer service and interpersonal skillsVerbal and written communication skillsAnalytical and problem-solving skills
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.ORAny combination of academic education, professional training or work experience, which demonstrates the ability to perform the duties of the position.
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.
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