Case Manager - CMA - Your Health Organization

GENERAL DESCRIPTION
The role of the Case Manager is responsible for ensuring a smooth registration process for new patients and efficient appointment scheduling for new and existing patients. The Case Manager will be responsible for coordinating appointments between patients and appropriate healthcare providers in accordance with the Company’s policies and procedures, maintain accurate records, and providing exceptional customer service.

AREAS OF RESPONSIBILITY
A successful Case Manager will be able to perform these essential duties and responsibilities. Reasonable accommodations may be made, in accordance with applicable law, to enable individuals with disabilities to perform the essential functions.
The following is a list of essential functions, which may be subject to change at any time and without notice. Management may assign new duties, reassign existing duties, and/or eliminate function(s).

•Appointment Scheduling: Schedule appointments for patients with healthcare providers based on availability, medical urgency, and patient preferences. Ensure all providers (which includes pharmacists, medical social workers, etc.), nurses, etc. Schedules are fully optimized.
•Patient Communication: Interact with patients via email, patient portal, telephone, text, in-person, etc. to gather necessary information, schedule and confirm appointments, and provide pre-appointment instructions. Respond to patient inquiries, resolve scheduling conflicts, and assist in rescheduling appointments when necessary.

•Records Management: Maintain accurate and up-to-date patient records, including demographic information, contact details, insurance information, appointment history, etc. Ensure confidentiality and adhere to privacy regulations when handling sensitive patient information.
•Coordination with Healthcare Providers and Staff: Collaborate closely with care team members and other staff members to ensure optimal scheduling and coordination of patient care. Communicate changes, cancellations, or rescheduling of appointments to relevant parties in a timely manner. Communicate with providers and staff via phone, email, Teams, Athena, or in-person.

•Insurance Verification: Verify insurance coverage and eligibility for patients ensuring accurate documentation of insurance information at all times. Collaborate with the billing department to address any insurance-related issues or concerns.
•Workflow Optimization: Continuously assess and improve appointment scheduling processes to enhance office efficiency and productivity. Identify areas for improvement and propose solutions to streamline operations.
•Customer Service: Provide exceptional customer service to patients, exhibiting a compassionate and empathetic attitude. Address patient concerns, inquiries, and complaints professionally and promptly, striving to meet patient needs and ensure their satisfaction.
•Administrative Functions: Perform general administrative tasks and support other staff as needed. Work assigned buckets, ticklers, census lists, and region’s scheduling voicemail tasks. Utilize the company’s software systems to enhance patient care and staff productivity.
•Collaboration and Coordination: Collaborate with internal and external resources to facilitate and ensure seamless operations.
•Communicate with patients, families, and caregivers.
•Must be available during normal work hours (unless previously approved by direct supervisor). Additional hours may be required to complete normal business functions and/or projects.
•Utilize the company’s software systems and update information as required.
•Participate in coaching calls.
•Perform other duties as requested or required, in the sole discretion of the Company.

MISSION EXPECTATIONS

Take responsibility for own work in completing tasks. Assist others so that the resources, assistance, or support is provided to achieve success in their daily work.
•Communicate, endorse, and demonstrate the Company’s mission, vision, and values.
•Prompt and regular attendance.
•Adhere to standards of behavior, dress code including name tag and approved uniform, personnel department, and company policies.
•Attend in-services and meetings on a regular basis.
•Promote a culture of outstanding customer service at all times.
•Must be available during normal work hours (unless previously approved by direct supervisor). Additional hours may be required to complete normal business functions and/or projects.
•Must possess the ability to deal tactfully with patients, employees, management, visitors, government agencies, and the general public and maintain an open-door policy for all employees.
•Must possess the ability to make independent decisions when circumstances warrant.

WORK ENVIRONMENT
The work environment characteristics described herein are representative of those an employee encounters while performing the essential functions of the job:
•May be exposed to housekeeping cleaning agents and chemicals, humidity, hot equipment, and/or noise.
•May be exposed to infections, communicable diseases, odors, bloodborne pathogens, excreta, and hazardous materials.

COMPLIANCE WITH POLICIES AND PROCEDURES
•Comply with all federal, state, and local laws and regulations.
•Knowledge of and compliance with Patient’s Bill of Rights.
•Must be knowledgeable of Medicare guidelines, applicable laws and regulations, and the Company’s policy and procedures.
•Adhere to the Company’s Code of Conduct / Ethics.
•Must exercise a high degree of confidentiality regarding patients, personnel, and the company.
•HIPAA compliant.
•Promote a culture of compliance.

PHYSICAL DEMANDS
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of the job. Reasonable accommodations may be made, in accordance with applicable law, to enable individuals with disabilities to perform the essential functions.
•Must be able to lift, reach, bend, push, pull, use repetitive hand motions, walk, and carry simultaneously.
•Must be able to withstand reaching, stooping, bending, kneeling, and crouching; walking and standing for periods of time; lifting up to fifty (50) pounds.
•Must be in good general health and demonstrate emotional stability.

QUALIFICATIONS

High school diploma or equivalent required while an associate’s or bachelor’s degree in healthcare is preferred.
•Previous experience in a medical or healthcare setting, preferably a scheduling or administrative role.
•Familiar with medical terminology, procedures, and insurance verification processes.
•Strong organizational and time management skills, with the ability to multitask and prioritize responsibilities effectively.
•Ability to read and communicate effectively.
•Strong written and verbal skills.
•Basic computer knowledge.
•Ability to manage and demonstrate effective leadership skills.
•Should demonstrate good interpersonal and communication skills under all conditions and circumstances.
•Ability to foster a cooperative work environment.
•Team player with ability to manage multiple responsibilities and demonstrate sound judgment.
•Must be able to work flexible hours and travel between offices, facilities, etc. Must be a licensed driver with an automobile