Medical Records

This job exists to: Assure an effective and efficient process is available for patients who need access to specialty care. The Referral Case Manager is responsible to maintain up to date knowledge of the managed care referrals process, specialty programs, and state rules and regulations for Medicaid, Medicare, and CHP Plus. There will also be the opportunity to assist with organizational development to maintain an effective referral process, ensure proper data collection, and create necessary reports.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

• Process referrals for managed care plans, specialty programs such as CCHN, to receive authorization and schedule needed appointments.

• Maintains up to date knowledge of managed care referrals process, specialty programs and state rules and regulations for Medicaid, Medicare and CHP Plus.

• Provides case management services to assure all needed information is obtained to facilitate an effective referral.

• Provides case management for all chronic diseases and preventative programs as requested.

• Updates and monitors all referrals being tracked per the time line specified in the referral procedure.

• Communicates with providers regarding pending referrals and issues pertaining to processing requested referrals

• Collects data and writes reports as requested.

• Assist with organizational development to maintain an effective referral process.

• Provides information/training to the clinic staff in regards to changes in referral process, change in no payer source referral, and state rules and regulation changes.

• Will work at another site as deemed necessary by the Clinic Director.

• Provides superb customer service to all customers (coworkers, out side customers).

• Request support from professional staff when needed.

OTHER DUTIES AND RESPONSIBILITIES:

• Maintains a safe work environment by remaining informed of and compliant with the clinic's safety policies, and by application of safe practices in area of own responsibility.

• Compliance:

• Knowledgeable of and compliant with laws and regulations governing area of responsibility.

• Responsible for reporting any potentially non-compliant conduct.

• Cooperates fully with our Compliance Officer in upholding our Compliance Plan.

SUPERVISION: No

SCOPE OF AUTHORITY:

• Provide resource coordination, follow up, and case management on all referral requests.

Progress is reviewed quarterly, and results are measured and formally evaluated annually.

POSITION QUALIFICATIONS:

Education and Experience:

• Bachelor's degree in the human services field preferred, but not required.

• Or high school/GED and four years in referral processing.

Knowledge, Skills and Abilities:

• Excellent verbal and written communication skills in English and Spanish required.

• Ability to flourish independently and in a team management system.

• Sensitivity to low income, ethnic minority community.

• Excellent organizational skills.

• Excellent tracking, and documentation.

• Excellent attendance

PRINCIPAL WORKING RELATIONSHIPS:

• Other pod members and site employees

• Patients

• Outside contacts such as community, other healthcare providers

• Other referral case managers within the organization

MATERIALS AND EQUIPMENT DIRECTLY USED:

• Fax

• Computer

• Telephone

WORKING ENVIRONMENT AND PHYSICAL ACTIVITIES:

• No risk of exposure to blood borne pathogens

• Usual office environment

• Ability to travel from clinic to clinic as required

• May require work outside of normal business hours

What we offer:

• Competitive Vacation Time

• Paid Holidays

• Medical Benefits

• Dental Benefits

• Vision Plan

• Retirement Plan

• Flexible Spending Account

• Growth Opportunities

Compensation: Approximately $15.22 - $17.65 per hour. All individual pay rates are calculated based on the candidate's experience and internal equity.

COVID-19 Vaccine (Required) Religious or Medical Exemptions available via application process.

Clinica Family Health is an Equal Opportunity Employer. We prohibit unlawful discrimination against applicants or employees on the basis of age 40 and over, race, color, religion, national origin, sex, disability, sexual orientation, gender identity, or any other applicable status protected by federal, state, or local laws.