Titanium Healthcare Inc.

Bilingual

• Care Coordination: Manage an assigned caseload of adult and pediatric members
• Conduct comprehensive assessments to determine the physical, emotional, and social needs of members
• Develop individualized care plans based on assessment findings, considering medical history, preferences, and specific needs
• Tailor care plans to individual needs and goals
• Coordinate and facilitate communication between healthcare providers, social workers, therapists, and other members of the care team to ensure a comprehensive and integrated approach to care
• Collaborate with Medical Doctors, Clinical Consultants, Housing Navigators and Leaders to make recommendations tailored to member needs
• Continuously monitor the progress of members and update care plans as needed per policy and compliance requirements
• Ensure prescribed treatments and interventions are being followed and communicate to PCP and specialty care providers any significant changes to member concerns along with any updates on member status
• Provide positive client service experience through multiple support channels including telephonic and in-person; the Enhanced Care Management program is high touch and in-person centered
• Maintain accurate and up-to-date records of assessments, care plans, and interactions with members
• Ensure compliance with relevant regulations and standards
• Complete all required documentation accurately in a timely manner and in accordance with company standards
• Provide leaders with case progress periodically and on a required basis
• Serve as an advocate for patients or clients, helping navigate the healthcare system, understand treatment options, and access the services required
• Provide education to members and their families on health-related topics, treatment options, and self-care strategies
• Identify and connect members with appropriate community resources, support services, and programs to address needs, such as housing assistance, financial aid, or counseling services
• Help plan and coordinate the discharge process for members leaving hospitals or long-term care facilities, ensuring a smooth transition to home or another care setting
• Opportunity to participate in training new employees
• Outreach: Conduct telephonic or in-person outreach efforts to current or prospective members
• Follow established policies to outreach, enroll, and exclude members
• Verify enrollment eligibility for the Enhanced Care Management program
• Complete referrals to the ECM program when necessary
• Partner with healthcare professionals, community, social support services, and other healthcare entities to locate members
• Answer inbound helpline and respond to member inquiries in a timely and professional manner
• Continuously improve knowledge of Company products and services to better assist members
• Utilize and review data sharing sites to collect and share patient health information and ER utilization with relevant care teams to initiate transition of care
• Review and verify the accuracy of member information file to ensure data is up to date and there are no errors
• Perform other duties as assigned or required per departmental policy

Bilingual Outreach Lead, Care Manager

• The LCM is responsible for an assigned caseload of adult and pediatric members
• Conduct comprehensive assessments to determine the physical, emotional, and social needs of members
• Develop individualized care plans based on assessment findings, considering medical history, preferences, and specific needs
• Tailor care plans to individual needs and goals
• Coordinate and facilitate communication between healthcare providers, social workers, therapists, and other members of the care team to ensure a comprehensive and integrated approach to care
• Collaborate with Medical Doctors, Clinical Consultants, Housing Navigators and Leaders to make recommendations tailored to member needs
• Monitor the progress of members and update care plans as needed per policy and compliance requirements
• Ensure prescribed treatments and interventions are being followed and communicate to PCP and specialty care providers any significant changes to member concerns along with any updates on member status
• Provide positive member client service experience through multiple support channels including telephone and in-person
• Maintain accurate and up-to-date records of assessments, care plans, and interactions with members
• Ensure compliance with relevant regulations and standards
• Complete all required documentation accurately, in a timely manner and in accordance with company standards
• Provide leaders with case progress periodically/required basis
• Advocate for patients or clients, helping them navigate the healthcare system, understand their treatment options, and access the services they require
• Provide education to members and their families on health-related topics, treatment options, and self-care strategies
• Identify and connect members with appropriate community resources, support services, and programs to address their needs, such as housing assistance, financial aid, or counseling services
• Plan and coordinate the discharge process for members leaving hospitals or long-term care facilities, ensuring a smooth transition to home or another care setting
• Participate in training new employees
• Perform other duties as assigned or required per departmental policy

Bilingual Lead Care Manager

• Facilitate access to primary care and behavioral health providers, as needed
• Responsible for working effectively with and as part of Titanium’s interdisciplinary team to provide high quality and effective care management to members
• Engage members in skilled therapeutic interactions to promote health behaviors and/or other behavioral health interventions within scope of practice
• Coordinate care using resource linkage and partnering with other professionals and organizations in the community to ensure quality of care for members
• Provide seamless transition of care that meets IEHP’s requirements for post ER visits and hospitalizations
• Complete regularly scheduled follow-up visits
• Provide care coordination through phone calls, emails, messages, updating calendars, scheduling appointments, data entry, and attending meetings
• Support the Behavioral Health Care Manager, Community Health Worker, and Care Coordinator with delegated tasks
• Collaborate on member care issues with other ECM care team members
• Participate in weekly systematic case reviews and ad hoc case reviews
• Consult with the Clinical Nurse Leader and/or the Behavioral Health Care Manager before taking any clinical action
• Strategize to engage members in care and conduct motivational interviews
• Provide health education to members within scope of practice
• Initiate a care plan and complete all necessary assessments of healthcare plan guidelines
• Understand and abide by all departmental and companywide policies and procedures
• Perform other duties and projects assigned

Bilingual RN Care Manager

Medical Billing and Coding

• Identify, notify, and work with internal team members on denial patterns and issues
• Collaborate with direct manager and other team members to resolve issues timely
• Evaluate patient accounts and take charge of insurance outstanding payments
• Manage, track, and resolve complex denied and voided claims until the claim is paid
• Achieve maximum reimbursement for services provided
• Prepare and submit billing data and medical claims to insurance companies, including 837 and 1500 claims
• Be proactive, creative, and flexible in determining, evaluating, researching, and resolving issues
• Organize and prioritize multiple activities to meet all external and internal deadlines
• Post payments accurately and timely to accounts
• Collaborate with revenue cycle manager and operational leadership on frequent issues to consult and advise on how to correct errors
• Develop and maintain claim resolution skills through continuous trainings, workshops, and education in collaboration with Revenue Cycle Manager
• Check eligibility on a bi-monthly basis for clients and compiling list of clients with terminated Medi-Cal as needed and provide management and operations team reports
• Prioritize tasks and create a tracking system of claims and health plans
• Respond to requests and communication timely (within 24-48 hours)
• Assist in the creation and review of billing procedures to ensure the company maintains compliance with local, state, and federal regulations
• Perform other duties and projects assigned

Medical Billing, Denial Specialist

Administrative Assistant

• Manage the CFO’s calendar, inbox, and communications with professionalism and discretion
• Coordinate meetings, agendas, and materials to support productive discussions
• Attend meetings and take accurate meeting notes, send summaries and action items timely post meeting
• Provides support on special projects by conducting research, compiling data, and coordinating with other departments to ensure deadlines are met
• Track follow-ups and deadlines, providing reminders to support timely completion by utilizing Asana and other related project management systems
• Support open access to the CFO by helping prioritize requests without acting as a gatekeeper
• Draft, edit, and proofread executive correspondence, presentations, and internal communications
• Manage insurance policies, including applications, and assist finance department with filings and notices
• Assist and support administrative department with other related duties, reconciliations, and tasks
• Coordinate logistics for company events, leadership meetings, lunch events, and overnight retreats
• Manage domestic and international travel end-to-end, including flights, accommodations, ground transportation, and real-time itinerary adjustments

Executive Administrative Coordinator – CFO

• Review and interview potential members to verify eligibility for enrollment in the Health Homes Program (HHP)
• Complete referral process when necessary
• Orient and educate members and their families by meeting with them to explain the role of the Care Coordinator
• Initiate a care plan and provide educational information related to treatments, procedures, medications, and continuing care requirements in coordination with healthcare providers
• Work with healthcare professionals, community and social support services, and other company employees
• Document evidence of care in the member’s record in a concise and timely manner using the EHR system
• Routinely check in or schedule appointments with assigned members
• Maintain documentation of all member encounters to complete established reporting requirements
• Communicate with providers and care team regarding member progress and care needs
• Explain and translate information related to the member’s care to and on behalf of the member, when necessary
• Identify and follow up on all referrals made to assure continuity of care and that member/family needs have been met
• Reassess care plans to ensure effectiveness in achieving desired outcomes for members and their family
• Address member questions and process member requests in a timely manner
• Investigate and direct member inquiries or complaints to appropriate staff members, including follow ups to ensure satisfactory resolution
• Follow established policies to enroll and disenroll members
• Maintain knowledge of community services and resources available to members including housing resources, financial/income assistance, transportation assistance and food assistance
• Follow established protocol around patients experiencing pain, safety concerns and/or mental health concerns and creates safety plans, if necessary
• Recognize signs of child and elder abuse and report appropriately to Child/Adult Protective Services
• Understand and abide by all departmental and companywide policies and procedures
• Comply with all safety and injury prevention policies and regulations
• Perform other duties as assigned or required

Bilingual Outreach Lead, Care Manager

Bilingual Lead Care Manager

Bilingual RN Care Manager

Medical Billing, Denial Specialist

Bilingual Lead Care Manager

Executive Administrative Coordinator – CFO

Bilingual Care Coordinator