DESCRIPTION
CLINICAL / CARE COORDINATION
- Coordinate resident care and supportive services to meet resident, family, health plan, and community-based program needs.
- Conduct comprehensive psychosocial and benefits-related assessments for residents participating in or eligible for the CalAIM program.
- Assist residents with applications, renewals, and troubleshooting related to SSI, Medi-Cal, Medicare, managed care health plans, and other public benefits.
- Work collaboratively with physicians, hospitals, health plans, social workers, discharge planners, and community agencies to ensure continuity of care and successful transitions.
- Advocate for residents to obtain medically necessary services, durable medical equipment, specialty appointments, transportation, and community supports.
- Monitor resident progress, follow up on referrals, and ensure care plans remain current and appropriate to resident needs.
- Educate residents and families regarding available benefits, entitlements, health plan resources, and long-term care options.
- Support residents with housing stability, mental health referrals, substance use resources, and social service needs as applicable.
ADMINISTRATIVE
- Support the overall goals and mission of the Company and community.
- Maintain accurate documentation of all case management activities in accordance with Federal, State, health plan, and Company requirements.
- Track resident eligibility, authorizations, renewals, and enrollment timelines for CalAIM and related programs.
- Communicate effectively with managed care organizations, Medi-Cal plans, county agencies, and interdisciplinary team members.
- Participate in interdisciplinary meetings, care conferences, trainings, and required in-services.
- Maintain knowledge of current Medi-Cal, SSI, CalAIM, and managed care regulations and program updates.
- Ensure confidentiality and compliance with HIPAA and all applicable privacy regulations.
QUALIFICATIONS
- Minimum 2 years of experience in case management, social services, healthcare coordination, assisted living, skilled nursing, or managed care preferred.
- Knowledge of California Medi-Cal, SSI/SSDI, CalAIM, Medicare, and managed care health plans required.
- Experience working with elderly, disabled, behavioral health, or vulnerable populations preferred.
- Strong communication, organizational, advocacy, and problem-solving skills.
- Ability to work independently and collaboratively in a fast-paced environment.
- Bachelor’s degree in Social Work, Human Services, Healthcare Administration, Nursing, or related field preferred.
- Bilingual English/Spanish preferred.
- Valid California driver’s license and reliable transportation preferred.
CONSUMER SERVICE
- Presents a professional image to residents, families, health plans, and community partners through dress, behavior, and communication.
- Adheres to Company standards for resolving resident and family concerns.
- Ensures resident rights, dignity, privacy, and confidentiality are always protected.
- Demonstrates compassion, professionalism, and cultural sensitivity when working with residents and families.
Pay: $25.00 - $32.00 per hour
Work Location: In person
