Care Coordinator, Transition of Care, Bilingual Spanish

This is a fully remote position, open to applicants in United States.

📋 Description

• Contact members via phone to provide support with referrals, authorizations, Home Health Care (HHC), Durable Medical Equipment (DME) requirements, medication refills, scheduling provider appointments, and conducting follow-ups.

• Generate cases and tasks while completing assessments in the Case Management module for hospital and Skilled Nursing Facility (SNF) discharges.

• Fulfill tasks assigned by the nurse and document the outcomes appropriately.

• Collaborate with the Case Manager to engage and oversee a panel of Special Needs Plan (SNP) members.

• Monitor new alerts and keep the Case Manager informed about any changes in member conditions, admissions, discharges, or new diagnoses.

• Build rapport with members, foster their trust, and serve as their advocate.

• Raise concerns with the nurse regarding any instances of non-compliance or changes in member conditions.

• Assist with outreach initiatives for members across all levels of Case Management Programs.

• Ensure member records are maintained and updated regularly.

• Send or fax communications to members, Primary Care Physicians (PCPs), and specialists.

• Request and upload medical records from PCPs, specialists, hospitals, and other healthcare providers.

• Attend Interdisciplinary Team Meetings and engage in member presentations when appropriate.

• Adhere to deadlines and prioritize tasks in accordance with departmental policies, standards, and requirements.

• Uphold the confidentiality of information shared among healthcare professionals.

• Carry out additional responsibilities as designated by the Case Management Supervisor, Manager, or Director of Care Management.

⛳️ Requirements

• A minimum of 1 year of experience in Health Care Independent Practice Associations (IPAs).

• At least 1 year of experience in processing referrals and prior authorizations.

• High School Diploma or GED; a Bachelor's degree or four additional years of relevant experience may substitute for educational requirements.

• Capability to read and interpret safety regulations, operational and maintenance instructions, and procedural manuals.

• Proficient in writing routine reports and correspondence.

• Strong customer service and communication skills.

• Ability to communicate in a positive, professional, and effective manner; lead, instruct, and collaborate with others.

• Strong problem-solving, organizational, and time management abilities.

• Capacity to thrive in a fast-paced environment.

• Familiarity with Managed Care Plans.

• Knowledge of Medi-Cal.

• Basic computer skills with a typing speed of 25 words per minute.

• Proficiency in Microsoft Outlook, Excel, and Word.

• Basic mathematical and reasoning abilities.

• Bilingual proficiency in English and Spanish.

🏝️ Benefits

• Comprehensive healthcare coverage.

• Opportunities for professional development and growth.

• Supportive work environment focused on teamwork and collaboration.