Case Management Assistant

The Case Management Assistant provides administrative and clerical support to the Case Management team, including Case Managers, Social Workers, and Nurse Navigators. This role assists with discharge planning, care coordination, insurance authorizations, referrals, patient transfers, and post-discharge documentation while ensuring timely communication with healthcare providers, patients, and community agencies.

Key Responsibilities

• Support discharge planning by coordinating referrals to skilled nursing facilities, rehabilitation centers, home health agencies, DME providers, and other post-acute care services.
• Fax and process discharge referrals and required documentation to outside agencies.
• Assist with obtaining insurance information and authorizations prior to patient discharge.
• Prepare and distribute post-discharge paperwork and documentation.
• Confirm facility acceptance, coordinate transportation, and communicate transfer details to Case Managers, Social Workers, and Nurse Navigators.
• Conduct Medi-Cal 10-bed searches and other placement searches, documenting results in the medical record.
• Communicate placement barriers and available options to the care coordination team.
• Prepare patient transfer packets, including medical records, reports, and required documentation.
• Maintain and update community resource directories.
• Assist with distribution of Medicare Important Message (IMM) letters and obtain required patient signatures.
• Support Medicare appeal processes by gathering documentation, submitting information to the Quality Improvement Organization (QIO), tracking outcomes, and communicating updates.

Required Skills

• Strong problem-solving and critical-thinking skills.
• Excellent written and verbal communication skills.
• Professional interpersonal skills with the ability to communicate effectively with patients, providers, and multidisciplinary teams.
• Self-motivated with the ability to work independently.
• Strong organizational skills and attention to detail.
• Ability to prioritize multiple tasks in a fast-paced healthcare environment.
• Proficiency with Microsoft Office Suite (Word, Excel, Outlook, PowerPoint).
• Experience using Epic Electronic Medical Record (EMR) system.
• Knowledge of payer types, including:
  • Medicare
  • Senior HMO (SR HMO)
  • Medi-Cal
  • Private insurance payers

Preferred Qualifications

• Previous experience in hospital case management, care coordination, utilization management, or discharge planning.
• Experience working with insurance authorizations and post-acute care referrals.
• Familiarity with healthcare documentation and medical records.