Clinica Family Health Services
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Bilingual Referral Case Manager
at Clinica Family Health Services
*Must be bilingual in Spanish and English*
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.
Please Note: This position will be cross trained as an office technician. You will work 20 hours/week as an Office Technician and 20 hours/week as a Referral Case Manager.
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 in particular by application of safe practices in area of own responsibility.
- 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
- Performs other duties and responsibilities, as required.
A. Education / Experience
- Bachelor’s degree in the human services field.
- Or HS/GED and four years in referral processing.
B. 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