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 performs trouble-shooting when problems situations arise and takes independent action to resolve complex issues.

• 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 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.
• Facilitates documentation and communication with CCS authorizations, third-party payers and clinical staff to ensure authorization of services.
• Responsible for ensuring all community resources are explored and/or exhausted prior to purchase of service utilization.
• Serves as an associate and resource to patients, providers, staff, and external customers regarding policies, benefits, and care coordination.
• Demonstrates excellent communications skills and interpersonal relationships.
• 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 2 years of 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 ethnically diverse population.