Position Overview

Ultimate Staffing Services is actively seeking a dedicated Medical Management Care Coordinator to join their client's team in California. This role involves supporting and coordinating resources for members referred to case management programs, ensuring compliance with state and federal regulations as well as company policies.

Responsibilities

• Work with case managers to assist members navigating the healthcare delivery system and home and community-based services.
• Monitor and respond to inbound case management inquiries and referrals, escalating to clinical staff as appropriate.
• Provide outreach to members to facilitate timely completion of Health Risk Assessments (HRAs).
• Support coordination of member care with PCPs, Specialists, Behavioral Health, and Long-Term Services and Supports providers.
• Assist with coordination of interdisciplinary care team involvement and individualized care plans.
• Support successful transitions of care between care settings.
• Follow UM policies and procedures for authorization requests and notifications.
• Produce and distribute internal reports including quality and admission/discharge reports.
• Respond to member and provider inquiries professionally and accurately.
• Maintain knowledge of community resources.
• Develop effective working relationships with internal and external stakeholders.
• Support and conduct non-clinical training and develop reference materials.
• Identify issues and trends and recommend operational improvements.
• Collaborate on quality improvement, utilization management, and member satisfaction initiatives.
• Attend departmental meetings, trainings, and coaching sessions.
• Perform other duties as assigned.

Qualifications

• Bachelor's Degree in a health-related field or equivalent experience, training, or coursework.
• Minimum three years of relevant experience in a healthcare or community setting providing care coordination of health and/or social services.
• Valid California driver license or ability to use alternative transportation.
• Knowledge of Medicare and/or Medi-Cal benefits, community resources, and case management principles preferred.
• Bilingual in Spanish, Vietnamese, Chinese, or Tagalog preferred.
• Knowledge of medical terminology preferred.
• Knowledge of Santa Clara County Health and Social Services preferred.
• Ability to adapt to changing situations and alternate between telephone and non-telephone tasks.
• Ability to meet accuracy and timeline requirements.
• Ability to work within an interdisciplinary team.
• Working knowledge of Outlook, Word, Excel, and case management software.
• Keyboarding accuracy and efficiency.
• Excellent verbal and written communication skills.
• Ability to prioritize and work under pressure.
• Sound judgment and decision-making ability.
• Ability to maintain confidentiality.
• Ability to comply with policies and procedures.
• Ability to perform the job safely.

Required Work Hours

Monday to Friday, 8:00 AM - 5:00 PM

Benefits

Competitive hourly pay ranging from $26 to $30, based on experience and qualifications.

Additional Details

The position requires working in a primarily office environment with frequent interaction with coworkers, supervisors, members, and providers via phone, in person, and electronic communication. The role involves regular bending, reaching, sitting, and standing, lifting and carrying files and supplies up to 5 pounds, reading printed materials and computer screens, frequent keyboard and hand movement, and maintaining concentration, attention to detail, and customer service focus.

All qualified applicants will receive consideration for employment without regard to race, color, national origin, age, ancestry, religion, sex, sexual orientation, gender identity, gender expression, marital status, disability, medical condition, genetic information, pregnancy, or military or veteran status. We consider all qualified applicants, including those with criminal histories, in a manner consistent with state and local laws, including the California Fair Chance Act, City of Los Angeles' Fair Chance Initiative for Hiring Ordinance, Los Angeles County Fair Chance Ordinance, and San Francisco Fair Chance Ordinance.