Referral Case Specialist

Title: Referral Case Specialist Base Salary Range: $43,680 - $45,760 plus benefitsFTE: Full-time, Non-ExemptOur Mission: The Mission of South Central Family Health Center is to improve the quality of life for the diverse Community of inner city Los Angeles by providing affordable and comprehensive health care and education in a welcoming and multi-cultural environment. To lead the way in health care in South Los Angeles, as the premier provider and employer of choice offering comprehensive, high quality, affordable, efficient and culturally responsive services.General Summary: The Referral Case Specialist will be responsible for processing referral requests from various sources to ensure compliance with federal, state, or Health Plan specific requirements. The referral specialist is accountable for facilitating timely authorizations and notifications as well as other referral management functions. This position works closely providing support to a clinical team in order to facilitate the administrative components of clinical referrals for various services.Provides day-to-day care coordination activities and referral follow-upProcesses referrals on daily basisFollows up on referralsResearch referrals and verifies information and ensure the prior authorization request is processed up on all specialist's reports for medical providers Initiates and manages clinical referrals for pre-authorizationAct as a liaison between the primary care provider patients, specialist, and health plans Verifies insurance coverage and completes pre-authorization following established process and procedures.Conducts culturally appropriate Multi-Component Care Plans and updates as need on a quarterly basisParticipates in case conferences and provide input related to care issues Provides case management Develops and implement a client-centered proactive Care ModelAssists in the development and implementation of a web-based Management Information SystemImplements quality improvement and evaluation activitiesQualifications and Experience:High School Diploma or equivalent requiredAA Degree, preferredCurrent BLS Certification requiredMust have minimum 2 -3 years in medical setting Understanding of medical terminology- familiar with Medicare, Medi-cal, etc.Bi-lingual/bi-literate English/Spanish preferredTop benefits or perks: As a team member at South Central Family Health Center, you'll enjoy competitive wages and generous benefits:Benefits: Health care, dental, life insurance403 (b) Retirement planEducation ReimbursementCareer development: Entry-level employees have opportunities to work in management, HR or other areas of the company.

Created: 2024-11-05