JOB PURPOSE:

The Care Manager Assistant will provide support to assigned facilities to ensure communication and authorization of medically necessary services provided in the post-acute setting with oversight from Department Manager, RN Case Manager or LPN Care Manager. In addition, may be asked to provide a wide range of administrative and clerical support to the Care Management Department.

KEY RESPONSIBILITIES:

The Care Management Assistant will provide support to assigned facilities to ensure communication and authorization of medically necessary services provided in the post-acute setting with oversight and support from Department Manager, RN Case Manager and LPN Care Manager.

KNOWLEDGE, SKILLS, ABILITIES:

• Reasonable demonstration of the ability to understand CMS and Commercial Insurance requirements to ensure compliance with regulations and standards.
• Must have basic knowledgeable of medical necessity review guidelines for commercial, Medicare, and Medicaid insurance products.
• Demonstrates the ability to communicate effectively via phone and email with our internal and external customers.
• Strong organization and ability to multitask is essential to success in this role.
• Identifies and escalates issues that affect the managed care process from a compliance and/or reimbursement standpoint.
• Escalates all cases that requires the assistance/approval of a Department Manager, RN Case Manager or LPN Care Manager, for example single case agreements.
• Must be proficient in the use of computer applications for daily use.
• Must be a self-starter and be able to work independently.
• Highly proficient in Microsoft Word, Intermediate Excel and Outlook required.

MINIMUM EDUCATION REQUIRED:

High School Diploma

MINIMUM EXPERIENCE REQUIRED:

2 years work experience

ADDITIONAL QUALIFICATIONS (Qualifications Preferred):

• Post-acute and/or healthcare industry experience is preferred.

Family Makes Us Stronger. Our family, your family, one family. Committed to loving, giving, and caring. United in making a difference.

We are eager to connect with you! Apply Now to get started at PruittHealth!

As an Equal Employment Opportunity employer, all qualified applicants will receive consideration without regard to race, color, religion, sex, national origin, disability, or veteran status.

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