Case Management Assistant- Peer Review

Job Details
Level
Entry
Job Location
Undisclosed
Remote Type
Fully Remote
Position Type
Full Time
Education Level
High School Diploma or GED
Salary Range
$16.00 - $21.00 Hourly
Travel Percentage
None
Job Shift
Day
Job Category
Admin - Clerical
Case Manager Assistant-Peer Review
This is a remote position. Hours will be 9 am - 5:30 pm PST.
The Peer Review Assistant is the clerical component of the Peer Review process. This position does not provide any clinical review, assessment, or determination. The primary responsibilities include a variety of support tasks with medical providers, medical case managers, and Peer Reviewers panel regarding the timely return of peer reports and peer consultant invoicing.
The Assistant will work directly with the medical case manager to provide additional resources to the Case Management staff. This position requires the ability to work independently to meet deadlines, as well as an excellent phone demeanor and a desire to provide exceptional customer service. The position requires knowledge of medical terminology and an understanding of referral criteria by clients and/or jurisdictions.
ESSENTIAL DUTIES AND RESPONSIBILITIES:

• Assists case manager and Peer Reviewers with the Worker's Compensation Utilization Review Peer Review process.

• Responds to phone inquiries from providers, patients, case managers, peers.

reviewers and directs to the appropriate handling party.

• Maintains peer-review tracking to ensure timeliness.
• Manages return correspondences from the Peer Reviewer within the Utilization Review system.
• Prints and mails correspondence to all necessary parties in accordance with the state

rules and regulations.

• Processes reports and maintains spreadsheets related to Peer Review determinations
• Sorts and handles mail.
• Provide assistance to the case manager by contacting medical providers for appointment dates, work status information and requesting of medical reports.
• Other duties as necessary as assigned by the supervisor.

Responsibilities of the position include, but are not limited to:

• Tracking of the Peer Review decision within the Case Management system
• Assist incoming calls to the Case ManagementPeer Review department.

• Monitor dedicated Peer Review queues/emails to review for peer determinations.
• Process all determinations and correspondence within 24 hours of receipt.
• Maintain daily/monthly referral logs.
• Identify trends and/or issues in referral patterns and communicate them with management.

***Other duties as assigned
Additional Functions and Responsibilities

• Demonstrates ability to meet administrative requirements, including productivity, time management, and Quality Assurance standards.
• Maintain documentation standards adhering to URAC standards and company policy and procedures.
• Maintain confidentiality- Knowledge of laws and regulations pertaining to HIPPA and PHI
• Other job duties as assigned.

qualifications
Education: High school diploma required. Medical background preferred and/ or Certified Medical Assistant preferred.
Experience: Experience in healthcare and/or managed care-related fields, Minimum of one year of working in a medical or managed care environment preferred. Medical Terminology preferred.
Knowledge, Skills and Abilities:

• Experience in healthcare-related fields
• Strong communication skills; customer service mindset; team player.
• Adheres to professional standards, codes of ethics, system, and department policies and procedures.
• Incorporates the philosophies of continuous quality improvement, customer service, and teamwork into daily routine.
• Excellent typing and keyboard skills (35-40wpm)
• Ability to work in a variety of computer systems proficiently.
• Ability to navigate a Windows environment, utilize Outlook, and the ability to create, edit, save, and send documents utilizing Microsoft Word and Microsoft Excel
• Ability to work within a paperless environment.

Special Equipment or Clothing:
Professional attire adhering to the Company Dress Code
Here are some of the benefits you can enjoy in this role:

• Medical, Dental, Vision, Life Insurance & Disability
• 401(k) plan
• Paid time off
• Paid holiday.

MENTAL AND PHYSICAL REQUIREMENTS
1. MENTAL EFFORT
a. Reasoning development:
Follow one- or two-step instructions; routine, repetitive task.
Carry out detail but uninvolved written or verbal instructions; deal with a few concrete variables.
Follow written, verbal, or diagrammatic instructions; several concrete variables.
X Solve practical problems; variety of variables with limited standardization; interpret instructions.
Logical or scientific thinking to solve problems; several abstract and concrete variables.
Wide range of intellectual and practical problems; comprehend most obscure concepts.
b. Mathematical development:
Simple additional and subtraction; copying figures, counting, and recording.
Add, subtract, multiply, and divide whole numbers.
X Arithmetic calculations involving fractions, decimals, and percentages.
Arithmetic, algebraic, and geometric calculations.
Advanced mathematical and statistical techniques such as calculus, factor analysis, and probability determination.
Highly complex mathematical and statistical techniques such as calculus, factor analysis, and probability determination; requires theoretical application.
c. Language development:
Ability to understand and follow verbal or demonstrated instructions; write identifying information; request supplies verbally or in writing.
Ability to file, post, and mail materials; copy data from one record to another; interview to obtain basic information such as age, occupation, and number of children; guide people and provide basic direction.
Ability to transcribe dictation; make appointments and process mail; write form letters or routine correspondence; interpret written work instructions; interview job applicants.
X Ability to compose original correspondence, follow technical manuals, and have increased contact with people.
Ability to report, write, or edit articles for publication; prepare deeds, contracts or leases, prepare and deliver lectures; interview, counsel, or advise people; evaluate technical data.
2. PHYSICAL EFFORT
a. Physical activity required to perform the job:
Sedentary work: Exerting up to 10 pounds of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects. Sedentary work involves sitting most of the time. Jobs are sedentary if walking and standing are required only occasionally and all other sedentary criteria are met.
X Light work:
a. Exerting up to 20 pounds of force occasionally
b. Exerting up to 10 pounds frequently
c. Exerting a negligible amount of force constantly to move objects
(If the use of arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most of the time, the job is rated for Light Work).
Medium work:
a. Exerting up to 50 pounds of force occasionally
b. Exerting up to 20 pounds of force frequently
c. Exerting up to 10 pounds of force constantly to move objects
Heavy work:
a. Exerting up to 100 pounds of force occasionally
b. Exerting up to 50 pounds of force frequently
c. Exerting up to 20 pounds of force constantly to move objects
Very heavy work:
a. Exerting in excess of 100 pounds of force occasionally
b. Exerting in excess of 50 pounds of force constantly to move objects
c. Exerting in excess of 20 pounds of force constantly to move objects

1. Visual requirements necessary to perform the job:

Far vision: clarity of vision at 20 feet or more
X Near vision: clarity of vision at 20 inches or less
X Mid-range vision: clarity of vision at distances of more than 20 inches and less than 20 feet
Depth perception: the ability to judge distance and space relationships, so as to see objects where and as they actually are
Color vision: ability to identify and distinguish colors
Field of vision: ability to observe an area up or down or to the right or left while eyes are fixed on a given point
2. PHYSICAL EFFORT (cont.)
FREQUENCY
c. Physical activity necessary to perform the job and frequency (e.g., continually, frequently, or occasionally):
Climbing: Ascending or descending ladders, stairs, scaffolding, ramps, poles, and the like, using feet and legs and/or hands and arms. Body agility is emphasized. This factor is important if the amount and kind of climbing required exceeds that required for ordinary locomotion.
Balancing: Maintaining body equilibrium to prevent falling when walking, standing, or crouching on narrow, slippery, or erratically moving surfaces. This factor is important if the amount and kind of balancing exceeds that needed for ordinary locomotion and maintenance of body equilibrium.
Stooping: Bending body downward and forward by bending spine at the waist. This factor is important if it occurs to a considerable degree and requires full use of the lower extremities and back muscles.
Kneeling: Bending legs at knee to come to a rest on knee or knees.
Crouching: Bending the body downward and forward by bending legs and spine.
Crawling: Moving about on hands and knees or hands and feet.
Reaching: Extending hand(s) and arm(s) in any direction.
Standing: Particularly for sustained periods of time.
Walking: Moving about on foot to accomplish tasks, particularly for long distances.
Pushing: Using upper extremities top press against something with steady force in order to thrust forward, downward, or outward.
Pulling: Using upper extremities to extent force in order to drag, haul, or tug objects in a sustained motion.
Foot
Motion: Using feet to push pedals.
Lifting: Raising objects from a lower to a higher position or moving objects horizontally from position to position. This factor is important if it occurs to a considerable degree and requires substantial use of the upper extremities and back muscles.
X Fingering: Picking, pinching, typing, or otherwise working with fingers rather than with the whole hand or arm as in handling.
X Grasping: Applying pressure to an object with the fingers and palm.
Frequently
Occasionally
2. PHYSICAL EFFORT (cont.)
FREQUENCY
X Talking: Expressing or exchanging ideas by means of the spoken word. Those activities in which workers must convey detailed or important spoken instructions to other workers accurately, loudly, or quickly.
X Hearing: Perceiving the nature of sounds with or without correction. Ability to receive detailed information through verbal communication and to make fine discriminations in sound, such as when making find adjustments on machined parts.
Feeling: Perceiving attributes of objects, such as size, shape, temperature, or texture by touching with skin, particularly that of fingertips.
X Repetitive Substantial movements (motions) of the wrists, hands,
Motion: and/or fingers.
Regularly
Regularly
Frequently