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Case Management Coordinator in Orange, California at Astiva Health

NewJob Function: Medical
Astiva Health
Orange, California, 92868, United States
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Job Description

Description:
  • Accurately enter confidential data into the case management system to ensure timely care coordination and outreach.
  • Verify member benefits and eligibility upon receipt of care coordination or case management.
  • Utilize DOFR or delegation agreements to drive decision making.
  • Coordinate and assist with patient appointments, transportation or utilize community resources.
  • Gather relevant information for the identified member population during assessment, care planning, interdisciplinary care team meetings, and transition of care.
  • Complete applicable patient assessments in a timely manner.
  • Coordinate with case manager to actively problem solve for patients.
  • Proactively outreach to patients to verify that needs are being met and services are being satisfactorily delivered.
  • Intervene at the client level to coordinate the delivery of direct services to clients and their families.
  • Coordinate with primary can specialty providers to provide care to patients.
  • Ensure all documentation and communication is complete and updated to partners at the IPA or MSO level and all clinical teams are updated to authorize patient services.
  • Review all available community resources prior to requesting patient services for use and authorization.
  • Serve as a resource for patients, providers, internal teams and external customers regarding plan policies, benefits, and care coordination.
  • Support the Utilization Management department by uploading member admission, home health and skilled nursing facility admissions. Collaborate with department leadership to coordinate calendars for meetings and coordinate interdisciplinary team communications.
  • Serve as the Outreach Liaison between the IPA/MSO’s for all delegation reports and communications.
  • Regular and consistent attendance
  • Other duties as assigned
Requirements:
  • High School diploma or GED required.
  • Minimum of 2 years of experience working in the healthcare industry.
  • Minimum of 1 year of prior experience working, training, or education within a healthcare environment.
  • Strong working knowledge of prior authorization, case management principals, and regulations governing Medi-Cal, Medicare, and other government and commercial healthcare programs.
  • Working knowledge or medical terminology.
  • Excellent written and verbal communication skills with the ability to build and foster strong interpersonal relationships.
  • Bilingual in a second language preferred.

Job Location

Orange, California, 92868, United States

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