Referral Case Specialist

Description

Title: Referral Case Specialist 

Base Salary Range: $43,680 - $45,760 plus benefits

FTE: Full-time, Non-Exempt

Our 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:   Referrals Case Specialist is responsible for coordinating interdepartmental patient referrals, processing referrals on the EMR and population software applications to ensure compliance with federal, state, or Health Plan specific requirements. Accountable for facilitating timely authorizations and notifications as well as other referral management functions to all specialty programs and serving as the primary liaison to partner organizations. Responsible for collecting data regarding quality measures and preparing reports for internal and external reporting purposes.

• Provide day-to-day care coordination activities and referral follow-up from various medical departments, such as Women’s health (OB), pediatrics, behavioral health, dental etc.  
• Follow up on  internal dental referrals and close completed referrals   
• Schedule patients and manage patient referrals for dental specialty programs in  conjunction with UCLA CBCE programs: Endodontics, Oral Surgery, and Pediatric Dentistry, as applicable
• Research referrals and verifies information and ensure the prior authorization request is processed accurately.
• Follows up on all specialist’s reports for medical providers   
• Responsible for ensuring the integrity and quality of Women’s health services delivered in the Comprehensive Perinatal Services Program (CPSP), Family Planning, OB/GYN, and other Referral related services.  
• Collaborate with other departments (Behavioral Health, Pediatrics, Dental and Primary Care) to connect patient to other services as part of their care.
• Act 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 update as need on a quarterly basis
• Assists the Referral & Medical Records Administrator with administrative duties on programs as it applies to  Medi-Cal Managed Care, Healthy Families, and CPSP.
• Participates  in case conferences and provide input related to care issues   
• Utilize i2i  tracks' perinatal tracking to collect and document all UDS prenatal data and keep data up to date throughout the pregnancy and postpartum.  
• Provide education and information to patients and their families, paying particular attention to providing education in a manner most suitable for an effective client learning experience.
• Assists in the development and implementation of a web-based Management Information System
• Implements quality improvement and evaluation activities

Qualifications and Experience:

• High School Diploma or equivalent required
• AA  Degree, preferred  
• Completion of formal health education program required, preferably at Associate of Science level.
• Knowledge of EMR systems and medical terminology.
• Must have minimum 2 -3 years in medical setting 
• Understanding of medical terminology- familiar with Medicare, Medi-cal, etc.
• Bi-lingual/bi-literate English/Spanish preferred

Top 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 insurance
• 403 (b) Retirement plan
• Education Reimbursement
• Career development: Entry-level employees have opportunities to work in management, HR or other areas of the company.

Salary : $43,680 - $45,760