We recruit, employ, train, compensate, and promote without regard to race, religion, creed, color, national origin, age, gender, sexual orientation, marital status, disability, veteran status, or any other basis protected by applicable federal, state or local law.
This position has primary responsibility for gathering relevant information for the identified member population during assessment, care planning, interdisciplinary care team meeting, and transitions of care. This position completes low risk problem solving and coordination for patients in collaboration with case manager.
Input data into the case management system to ensure timely care coordination and outreach.
Verifies member benefits and eligibility upon receipt of care coordination and/or case management.
Utilizes DOFR and/or delegation agreements to drive decision-making.
Coordinates and assists with patient appointments, transportation, and/or community resources.
Has primary responsibility for gathering relevant information for the identified member population during assessment, care planning, interdisciplinary care team meeting, and transitions of care.
Completes applicable patient assessments.
Completes low risk problem solving and coordination for patients in collaboration with case manager.
Outreach to patients to verify that needs are being met and services are being delivered.
Intervenes at the client level to coordinate the delivery of direct services to clients and their families.
Coordinates with Primary Care and Specialist providers.
Collaborates and facilitates interdisciplinary team communications.
Perform additional duties as assigned.
Process model of care required elements within the dept. targets.
Meets minimum caseload requirements.
Achieves minimum audit score for core responsibilities.
High School Diploma or equivalent required.
Prior experience working in a clinic/health care call center.
Minimum 1 year experience working in a health care environment; knowledge of prior authorization and case management regulations governing Medi-Cal, Commercial, Medicare, CCS, and other government and commercial programs.
Prefer experience in a managed health care environment, preferably IPA, HMO, or Health Plan.
Prefer experience working with an diverse population.