Clinical Case Assistant - MyCare Ohio, CareSource

Overview

Reports to: Program Supervisor

FLSA Status: Non-Exempt

Dedicate yourself to an Organization and Mission you can be proud of by joining the Western Reserve Area Agency on Aging!

Our Mission: We provide choices for people to live independently in the place they want to call home.

About Us: Western Reserve Area Agency on Aging (WRAAA) is a private non-profit corporation located, organized and designated by the State of Ohio to be the planning, coordinating and administrative agency for federal and state aging programs in Cuyahoga, Geauga, Lake, Lorain and Medina Counties. It is one of twelve Area Agencies on Aging (AAAs) in the state organized together with local service provider organizations and the Ohio Department of Aging (ODA) to form the state s public aging services network.

The network works together to create opportunities for Ohioans to receive needed home and community services and supports; and to age successfully in their own homes and communities.

The Clinical Case Assistant acts as support for the Supervisors and Waiver Services staff (Care Managers & Waiver Service Coordinators) at the WRAAA. This role may include telephone outreach to program participants, tracking of data, and referrals to providers for services.

• Communicates information to staff using PIMS (PASSPORT Information Management System) or managed care platform, or health plans (Next Generation/Group
  8) as assigned to update Care Manager or Waiver Service Coordinator and supervisor as to status of the individual upon request.
• Arranges transportation for consumers/members at the request of the Care Manager or Waiver Service Coordinator. Makes referrals to transportation providers, faxes authorizations, alerts Care Manager or Waiver Service Coordinator of any billing issues or other problems in implementing transportation services. If working with a managed care plan, follow protocol for transportation requests as identified by managed care plan.
• Assist Care Manager or Waiver Service Coordinator with completion of member service authorization, conduct provider referrals for services, home modifications follow-up, ordering durable medical equipment, fax authorizations- provider/individual attestations of care plan/service plans, and communicate any issues related to delivery of services as identified to staff.
• Assist with the “migration process” of individuals when the individual migrates to another program or health plan.
• Maintains consumer/member and provider confidentiality according to HIPPA and Agency policy.
• Meet time frames for timely and accurate completion of documentation.
• Complete Centralized Referral process for initial, reassessments or change in services including contacting consumers/members or families to verify the start of services, equipment delivery and or satisfaction of services/equipment.
• May develop spreadsheets and word documents as needed for departmental use.
• Communication with enrolled consumer/members and providers around program services, With appropriate documentation in the clinical record as needed.
• Uploading member/consumer records and documents into the medical record as needed.
• Assist Supervisors with monitoring and managing reports that govern the work in CSSD department.
• Attends assigned team meetings.
• May perform occasional duties such as the following:
• Retrieve voicemail messages for absent Care Managers/WSC or as assigned.
• Handle incoming consumer/member, provider and other communication request for absent Care Mangers/WSC or as assigned.
• Provides coverage for other Clinical Case Assistants as needed.
• Must comply with all State and Federal Waiver assurances as part of the three-party agreements between the Ohio Department of aging and/or the Ohio Department of Medicaid and the Center for Medicare and Medicaid Services.
• Performs other duties as assigned by Program Supervisor.
• All staff have the responsibility and authority to propose ways to improve quality and to fully participate in quality improvement efforts.

• High school graduate with two years of business, accounting, bookkeeping, medical/insurance claim processing and/or human services/health…