Case Manager Assistant- UR

Job Location(s) US-CA-Santa Ana | US-SC-Summerville
Job ID
# of Openings
Case Management
Job Type
Regular Full-Time



Work directly with the Supervisor and Manager to provide additional resources to the case management staff. This position does not provide any clinical review or decisions.

This individual is responsible to ensure the referrals are set up in the Utilization Review/Case Management system and promptly assign to the case manager. The Case Management Assistant will answer incoming calls, screen, respond and route the calls. 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, the understanding of referral criteria by client and/or jurisdictions.




  • Responds to phone inquiries from providers, patients, case managers, peer

reviewers and directs to the appropriate handling party

  • Prints and mails correspondence to all necessary parties in accordance with state

rules and regulations

  • Processes reports and maintains spreadsheets
  • Sorts and handles mail
  • Other duties as necessary assigned by supervisor



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

  • Assist incoming calls to the case management department
  • Monitor dedicated queues/emails
  • Process all determinations and correspondence within 24 hours of receipt
  • Set up of member within the case management system
  • Assist incoming calls to the case management referral department
  • Monitor dedicated referral emails to review for new referrals and correspondence
  • Monitor workflow of referrals and identify areas where daily assistance is needed
  • Work with the branch locations and staff to complete and provide necessary information for referrals
  • Process all referrals and correspondence within 24 hours of receipt
  • Maintain daily/monthly referral logs and assist with peer review invoicing
  • 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

Education: High school diploma required. Medical or Managed Care background preferred and/ or Certified Medical Assistant

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


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