Conduct outreach to members for referrals, authorizations, medication refills, and provider appointments
Complete tasks and assessments related to hospital and skilled nursing facility (SNF) discharges in the Case Management system
Collaborate with RN Case Managers to support a panel of SNP members
Monitor member alerts related to condition changes, admissions, discharges, and new diagnoses
Build trusted relationships with members as a care liaison and advocate
Maintain accurate, up-to-date documentation of all member interactions
Communicate with provider offices, including faxing, mailing, and requesting medical records
Participate in interdisciplinary team (IDT) meetings and member case reviews
Ensure confidentiality of member data and meet all departmental deadlines
Requirements
Bilingual in Spanish or Vietnamese (required)
Minimum 1 year of experience in a healthcare IPA setting
Minimum 1 year of experience handling referrals and prior authorizations
High school diploma or GED (Bachelor’s degree preferred, or 4 additional years of experience in lieu of degree)
Proficient with Microsoft Outlook, Word, and Excel; minimum typing speed of 25+ WPM
Strong verbal and written communication skills
Excellent organizational and time management skills
Familiarity with Medi-Cal and managed care plans
Benefits
Meaningful opportunity to work with a passionate team that values innovation
Flexible work arrangements
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
case managementreferralsprior authorizationsdocumentationmember assessmentscondition monitoringmedical records managementtyping speed 25+ WPMMedi-Calmanaged care plans
Soft skills
bilingual in Spanishbilingual in Vietnameseverbal communicationwritten communicationorganizational skillstime managementrelationship buildingadvocacycollaborationconfidentiality
Certifications
high school diplomaGEDBachelor’s degree (preferred)