Case Management Assistant needed in the Sacramento area. This person ensures efficient processing of referral requests, timely authorizations and adherence to protocols. This is a long term, full-time, contract position for approximately 6 months or longer covering a leave of absence. 

Responsibilities: 

• Read, comprehend, and understand referral requests, processing them within the scope of practice or forwarding them to the appropriate nurse.

• Review referral requests, obtain or provide authorization as needed, and manage benefit-related functions while ensuring compliance with payer obligations.

• Accurately data enters confidential member information including eligibility, routine referrals, and authorization information.

• Monitors and resolves referral/authorization orders promptly, adhering to standard workflows and maintaining accuracy in verifying codes and insurance coverage.

• Addressing customer concerns from providers, staff, and patients, ensuring courteous and effective communication.

• Daily management of pending referrals, ensuring timeliness standards are met and proactively addressing anticipated problems.

• Communicates effectively through written and oral means, documenting interactions professionally and maintaining the strictest confidentiality with protected health information.

Requirements:

• Familiarity with Utilization Management protocols and understanding of client and payer responsibilities for payment.

• Knowledge of HMOs preferred.

• Proficient in database entry and maintaining accuracy with attention to detail.

• Strong oral and written communication skills.

• Effective interpersonal and time management skills.

• Ability to work independently in a fast-paced environment with shifting priorities.

• Intermediate computer skills and word processing proficiency.

Preferences:

• Previous experience in case management or a related healthcare field.

• Familiarity with CPT, ICD, and/or HCPCS codes.

Experience working in a healthcare setting with knowledge of health plan contracts and requirements.

Pay Range $19 -$21 per hour

Must be able to clear a thorough drug screening and criminal background check, provide a minimum of two supervisory references and proper documentation to verify eligibility to work in the USA.

Other compliance factors may be involved, depending on position. River City Staffing is an Equal Opportunity Employer.

EXPERIENCE RCS

River City Staffing, Inc. (RCS) specializes in the placement of highly skilled administrative and finance and accounting professionals. Whether you are seeking temporary placement, temp to hire or direct hire opportunities, RCS has built our reputation on adding value to each and every candidate we meet. At RCS, you will experience expertise, consultation, follow up, advocacy, partnership and so much more. Contact us today! www.rivercitystaffing.com