Care Management Assistant- Care Management - Cookeville Regional Medical Center

The Care Management Assistant (CMA) functions as a member of a multidisciplinary health care team with the guidance of the nurse care managers and social worker care managers, assisting in facilitating appropriate patient placement; utilizes hospital and community resources for continuity of patient care; collaborates with medical staff, HIM and other hospital departments and staff. The CMA is responsible for coordinating insurance reviews and issuance of authorization numbers through submission of required clinical information. The CMA will work directly with all Care Management staff, Business Office, Patient Access, and along with the Hospital’s Revenue Cycle to ensure quality and efficiency of certain elements of claims processing, denial prevention, and denial management. Provides office and referral management support services; assists the Utilization Review Team in obtaining medical records, documenting care information in the system, performing data entry into appropriate databases for monitoring and tracking, and following up on phone calls as directed. In addition to performing the essential functions listed below. Other duties as assigned.

Education:

1. High School graduate or equivalent required
2. Business college or associate degree desired
3. Previous healthcare experience/ medical knowledge preferred
4. Ability to read, write and comprehend medical terminology
5. Effective communication skills in written and verbal performance
6. Staffing and scheduling skills
7. Working knowledge of the Microsoft office software: Outlook, Excel, Word
8. Ability and willingness to learn new tasks and skills

Experience: Three to five years of health care management. A previous background in Case Management/Utilization Review preferred. Knowledge of accepted Nursing procedures in designated patient populations as acquired through 5 years of clinical experience preferred.
Experience and basic knowledge of computer software. Must possess ability to work well under pressure, to function independently and dependently, and flexible in applying knowledge to a variety of situations. Must possess good customer relations and tact. Must have proficient in Excel, Word, Access, and Power Point. Develops educational material and tools relative to insurance regulations and improvement for staff.

PI256467089