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NAS Case Manager

MACT Health Board Inc.
 San Andreas, CA

POSITION TITLE: Native American Services Case Manager

LOCATION: San Andreas, California

STATUS: NON-EXEMPT

DEPARTMENT: NATIVE AMERICAN SERVICES

SUPERVISOR: Native American Services Director

STARTING SALARY: $22.56-$27.10/Hour

POSITION SUMMARY:

The Native American Services (NAS) Case Manager serves as a trusted liaison between our Tribal communities, Native American patients, and the services offered by MACT Health Board, Inc. NAS Case Managers are situated throughout MACT’s footprint, serving each of our four counties’ (Mariposa, Amador, Calaveras, and Tuolumne), Native American population. As an NAS Case Manager, you will be responsible for:

  • Working as part of an interdisciplinary team of professionals, engaging and providing case management services to Native Americans who qualify for Direct Care or Purchased & Referred Care (PRC) benefits
  • Verifying eligibility of Native American patients for Direct Care or Purchased & Referred Care benefits
  • Advising eligible patients and staff about PRC benefits
  • Coordinating and scheduling patient visits between MACT’s Medical, Dental, Behavioral Health, and Optometry services as well as external specialty services
  • Following each PRC Patients’ treatment plan from scheduling visits and making reminder calls to contacting specialty offices and retrieving consult/referral reports
  • Assisting PRC patients with pharmacy needs, prior authorizations for prescription drugs and medical services, and referrals to specialists
  • Documenting patient communications and outreach efforts as well as other communications and efforts related to PRC patients’ care in the electronic health record system
  • Working with external partners, e.g. social services, ICWA advocates, adoption agencies, etc. to ensure appropriate documentation is received and timely access to care is provided
  • Providing support to clinical staff such as front office coverage, e.g. scheduling visits, answering telephones, checking-in patients and collecting payments, running insurance/eligibility verification, and back office coverage, e.g. obtaining prior authorizations for prescription drugs and medical services and working referrals for non-PRC patients, as needed

The position requires an awareness and keen appreciation of American Indian traditions, customs, and socioeconomic needs and the ability at all times to meet and deal effectively with patients which requires tact, courtesy, discretion, resourcefulness and good judgment in handling functions in a sensitive matter.

PRIMARY RESPONSIBILITIES:

  1. Determine Native American Direct Care and PRC eligibility for services and inform client of eligibility status.
  2. Explain eligibility of services to Native American patients. Ensure patients are receiving all eligible benefits. Assist patient in applying for benefits when eligible, including Medi-Cal and CMSP.
  3. Inform patient of PRC referral form process and forward to PRC Department in a timely manner.
  4. Consult with patients regarding the status of their PRC claim.
  5. Manage referrals from beginning to end for PRC-qualified patients; may include: providing copies of PRC referrals to the appropriate departments or agencies, working with electronic systems to track progress of the referral, maintaining open communication with patients for support and education, etc.
  6. Obtain necessary documentation to prepare authorization for services.
  7. Assist with scheduling of referrals and outside services
  8. Collect bills from patient for services received from outside providers.
  9. Verify primary and secondary insurance coverage, obtain prior authorizations, obtain letters of medical necessity, verify co-pays, correspond with physicians, health care providers and patients to complete a thorough insurance investigation to include eligibility, deductibles, co-pays, etc.
  10. Coordinate direct care patient eligibility and policies
  11. Work with the local social services department to ensure patient follow up on assisted applications.
  12. Ensure patients are receiving all eligible benefits. Assist patient in applying for benefits when eligible, including Medi-Cal and CMSP.
  13. Work with the local social services department to ensure patient follow up on assisted applications.
  14. Continue improvement of duties to streamline processing.
  15. Assist eligible Elders to receive services through the Elder program.
  16. Explain eligibility for services to Native American Diabetic patients.
  17. Maintain confidentiality with patient information at all times.
  18. Comply with all MACT policies and procedures at all times.
  19. Other duties as assigned.

MINIMUM QUALIFICATIONS:

  1. Must have a high school diploma or equivalent.
  2. Knowledge & experience with medical and dental terminology.
  3. Experience with Advance Beneficiary Notices and Medicare Medical Necessity.
  4. Customer service experience in a medical and dental field preferred.

MANDATORY REQUIREMENTS:

  1. Be a qualified American Indian
  2. Must pass Occupational Health Screening.
  3. Must possess a valid form of identification as listed on the U.S. Department of Justice I-9 form, verified using the E Verify system.
  4. Clean DMV driving record and MACT auto insurance driving eligibility (determined by auto insurance carrier)
  5. Proficient in problem resolution, detail analysis, and accuracy.
  6. Ability to work as part of a professional team.
  7. Ability to work independently and submit weekly reports of progress to direct supervisor.
  8. Ability to prioritize tasks and complete assignments in a timely manner.
  9. Good oral and written communications, patience and tact.
  10. Well organized.
  11. Intermediate skill level of computers and Microsoft Word, Excel, and Outlook.

MANDATORY REQUIREMENTS:

  1. Must pass Occupational Health Screening.
  2. Must possess a valid form of identification as listed on the U.S. Department of Justice I-9 form, verified using the E Verify system.
  3. Clean DMV driving record and MACT auto insurance driving eligibility (determined by auto insurance carrier).

AMERICAN INDIAN PREFERENCE

Preference in filing of a vacancy will be given to qualified American Indian applicants in accordance with the Preference Act (Title 25, U.S. Code, Sections 472 & 473) and Public Law 93-638, provided the applicant has submitted appropriate verification of Indian preference for employment. Other than the aforementioned requirement, the MACT Health Board, Inc. is an Equal Opportunity Employer.

NOTICE OF DRUG-FREE WORKPLACE ACT REQUIREMENT:

MACT Health Board, Inc. is required to implement the Drug-Free Workplace Act of 1988, 45 CFR Part 79, Subpart F. As such it is unlawful for employees to manufacture, distribute, dispense, possess, or use a controlled substance on the job site. Employees who are reasonably suspected of violating this act may be subject to drug testing as a condition of employment. Employer required fitness examinations shall include drug testing as evidence of employee and employer compliance with the Drug-Free Workplace Act.

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