Care Coordination Representative

Western Dental Orange , CA 92856

Posted 2 months ago

Processing of Medicaid/Medical treatment referrals and authorizations. Responsible for monitoring backlog of NEA and TAR at office level, processing pending items and tracing of open referrals/treatment authorizations.

  • Run weekly reports for pending referrals, referrals and/pre-authorizations

  • Submit referrals/ pre-authorizations requests

  • Process attachments through NEA

  • Keep daily log of referrals/ pre-authorizations submission

  • Request any additional attachments that are needed from the dental office in order to submit referrals/ pre-authorizations request

  • Research and follow-up on referrals/ pre-authorizations and reprocess as needed

  • Coordinate approved referrals to contracted specialty providers

  • Contact dental carriers as needed for follow

  • Verify eligibility as needed

  • Stay up to date with payer reimbursement changes

  • Case Management

  • Management of charge backs

  • Communication with offices and teams (written and verbal)

  • Act as Subject Matter Expert for Medicaid/Medical treatment referrals

  • Ability to travel to locations as needed


  • Dental experience preferred

  • Knowledge Managed Care, Denti-Cal and Medicaid, preferred

  • Ability to multitask

  • Good customer service and communication skills

  • Easily adapts to change

  • Other duties as assigned by direct supervisor

icon no score

See how you match
to the job

Find your dream job anywhere
with the LiveCareer app.
Mobile App Icon
Download the
LiveCareer app and find
your dream job anywhere
App Store Icon Google Play Icon

Boost your job search productivity with our
free Chrome Extension!

lc_apply_tool GET EXTENSION

Similar Jobs

Want to see jobs matched to your resume? Upload One Now! Remove
Care Manager Social Worker Lcsw

St. Joseph Health

Posted 1 week ago

VIEW JOBS 4/2/2020 12:00:00 AM 2020-07-01T00:00 We are looking for a Care Manager, Social Worker, LCSW with Comprehensive Care Clinic Department at Heritage Helathcare. Location: Orange, CA Schedule: Part time - 80 Biweekly hours Shift: 8-Hour, Days Job Summary: Care Management is a collaborative practice model including the patients, nurses, social workers, physicians, other practitioners, caregivers and the community. The care management process encompasses excellent communication, both verbal and written, and facilitates care along a continuum through effective resource coordination and addressing the psych social needs of the patient.The goal of the Care Manager, Social Worker is to advocate for and assist the patient in the achievement of optimal health, access to care, and appropriately utilizing resources. The Care Manager Social Worker utilizes the following processes to meet the patient's individual healthcare needs: assessment, planning, implementation, coordination, monitoring and evaluation of the plan of care. The management of resources and the coordination of the continuum of care will be performed in a manner consistent with the mission vision and core values of St. Joseph Health. Skills: * Knowledge of managed care principles, utilization management, case management and healthcare provided throughout the continuum * Knowledge of physical and psychological characteristics of disease processes, recognizes potential clinical problems, and recommends intervention in a preventative, pro-active way * Excellent interpersonal, verbal and written communication skills. * Ability to problem-solve * Ability to access and evaluate community resources to meet patient's needs * Ability to handle multiple tasks at a time and remain organized * Ability to work autonomously but demonstrates the ability to work collaboratively on a team * Ability to work in an ambiguous environment; work effectively under pressure due to changes in priorities * Excellent computer and IT system knowledge * Possesses the knowledge and skills necessary to communicate with third party payers * Establishes and maintains a good rapport with physicians and interacts well with all internal and external customers in a professional and courteous manner Minimum Position Qualifications: Education: * Licensed Clinical Social Worker (LCSW) in psychology or counseling Experience: * Six (6) months of clinical experience in an HMO, medical group, affiliated model, hospital or medical office/clinic setting Computer Skills: * Basic computer skills including Windows, Microsoft Word, internet navigation and an e-mail system Other: * When driving is required, a Valid California Driver's License and automobile insurance for employee-owned vehicles. Preferred Position Qualifications: Experience: * Three (3) years experience in utilization management and/or case management highly desirable. * Psychiatric chemical dependency treatment * Managed care experience License / Certification: * Certification in Case Management (CCM, ACM) Other: * Proficiency in Milliman (Mcg) Care Guidelines St. Joseph Heritage Healthcare (SJHH) is one of California's most respected medical groups. With over 3,000 employees and 75 locations throughout California, including, Northern California, Orange County, High Desert and Los Angeles County, SJHH has been continually recognized as a leader in quality, customer service and information technology. This kind of success is the result of team work, a commitment to excellence and a strong adherence to the organization's mission, vision and values. St. Joseph Heritage Healthcare (SJHH) provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability or genetics. In addition to federal law requirements, St. Joseph Heritage Healthcare (SJHH) complies with applicable state and local laws governing nondiscrimination in employment in every location in which the company has facilities. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training. St. Joseph Health Orange CA

Care Coordination Representative

Western Dental