Do you keep thinking, there's got to be a better way for a nurse to contribute to healthcare?

Are you a nurse who wants to be part of revolutionizing medicine?

The Medical Assistant is responsible for taking phone calls and relaying messages as appropriate, initiating and entering new cases into software for P3CM referrals, sending introductory service letters to consumers and other letters as directed, and forwarding information to the assigned Medical Management Nurse. The MA reviews logs and reports for potential referrals to the Director of P3CM Medical Management and provides other services to the Department as directed by the Director of Medical Management. Under the supervision of the Department Manager, the MA also assists with the P3CM Medical Management process as needed to facilitate and expedite the P3CM process in a timely and efficient manner. The MA provides administrative, secretarial, and clerical support.

Essential Duties and Responsibilities

Medical Management Department:

• Attend Medical Management Department meetings and meetings of the Quality and Excellence Committee, and act as Secretary, record Minutes and attendees
• Distribute various updated information to the members of the P3CM Medical Management Department such as phone extension lists, new groups list, etc.
• Run electronic reports as requested by the Manager.

For P3CM Medical Management:

• Initiate and enter case referral information into software system for P3CM Referrals; Send P3CM Intro Packets and Case Closure Letters with Satisfaction Surveys
• Update the Case as required to document that the Referral information was completed and the case was initiated, P3CM Intro Packet sent, Case Closure Letter sent, etc.
• Organize and maintain closed P3CM Medical Management paper records, if any, in secure, locked file cabinet
• Update and create new P3CM Medical Management materials/forms as needed with information and direction as provided by the Director of P3CM Medical Management or designee
• Order supplies/materials for P3CM Medical Management Program/Nurses as needed

For Utilization Management:

• Return "No Precert Needed” phone calls
• Contact physicians' offices as needed to request information when necessary and as directed by the Manager
• Mail pre-determination, LOC, and approval letters
• Forward Voice Mails to appropriate Nurses
• Copy medical records and fax records for independent physician reviewers
• Request discharge dates and clinical updates on hospitalized members
• Obtain demographic information when inbound callers wish to initiate precertification requests. Non-clinical staff are not responsible for conducting any UM review activities that require interpretations of clinical information. Licensed clinical staff are always available to non-clinical administrative staff while performing initial screening.
• Transfer callers wishing to provide clinical information to RNs
• Assist RNs, in emergency situations, to procure the necessary 911 services for patients utilizing specified scripts

Knowledge, Skills, and Abilities

• employ analytical thinking
• perform duties in an ethical manner
• manage change
• prioritize, analyze, and negotiate multidirectional communication for consensus
• commit to quality healthcare management service(s)
• understand shared leadership
• able to work with a team
• collaboration skills
• utilize technology in a proficient manner

Education & Experience

• High School Diploma required. Associates Degree or equivalent combination of experience, skills, education (including other relevant non-traditional degree programs, certifications, or job training programs) preferred.
• Computer skills including data entry and word processing at minimum 90 words per minute
• Familiarity with internet access
• Familiarity with ERISA requirements for Utilization Management preferred
• Valid driver's license required
• Medical office/facilities experience required

Company Perks:

• Growing business.
• Paid holidays off.
• Generous PTO plan.
• Health benefits.
• 401k with company match.
• Caregiver support platform
• Relaxed/casual dress code.
• Business office / call center environment (no hands-on bedside care).
• New challenges and learning opportunities DAILY – never boring!
• A chance to make a real difference in the lives of your patients.