Referral Case Specialist Manager

Description

Title: Referral Case Specialist Manager

Base Salary Range: $70,000 - $75,000 plus benefits

FTE: Full-time, Exempt

We seek a dynamic and experienced Referral Case Specialist Manager who wants to make a difference in our community. We want to hear from you if you thrive in a fast-paced, caring, and compassionate environment!

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 multicultural 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: Supervise and maintain a caseload of clients enrolled in health care programs. Provides leadership to the Referrals team and assists in implementing policies and protocols. The ideal candidate will perform some of the following essential duties.

• Supervise the daily operations of the referral department, ensuring high-quality and timely processing of referrals to minimize delays and reduce insurance denials.
• Oversee and manage staff performance, including training, coaching, scheduling, conducting evaluations, and administering disciplinary actions as necessary to support team effectiveness and accountability.
• Ensure timely processing of internal and external referrals and authorizations in accordance with organizational policy and payer requirements.
• Ensure compliance with HIPAA and other federal/state regulations related to patient information and referrals.
• Prepare for and actively participate in internal and external audits, ensuring referral department compliance with organizational policies and regulatory standards.
• Collaborate with the compliance department and other relevant teams to respond to and resolve patient grievances and complaints in a timely and professional manner, ensuring patient satisfaction and adherence to regulatory standards.
• Assist providers, members and/or internal patients with cases pertaining to referral questions, issues and authorizations
• Reconcile claims pended issues in a timely manner per health plan/department procedures
• Follows up on all specialist's reports for medical providers
• Conducts culturally appropriate Multi-Component Care Plans and update as need on a quarterly basis
• Participates in case conferences and provide input related to care issues
• Receive and review incoming phone and case management log reports and determine course of action (i.e., set up authorization or denial per Clinical Director and /or plan guidelines).
• Develops and implements a client-centered, proactive Care Model
• Attendance and punctuality are essential in order to provide quality of care to patients, face-to-face interaction with patients, and to work with provided healthcare equipment collected at clinics

Qualifications and Requirements:

• High School Diploma or equivalent required
• BA Degree, required
• Demonstrate knowledge of safety, infection control & emergency policies and procedures

Experience & Abilities:

• Must have a minimum of 2 -3 years in a medical setting
• Working knowledge of medical terminology preferred
• Type 45 wpm
• Bi-lingual/bi-literate English/Spanish preferred
• Conduct oneself with professionalism in dealing with sensitive and confidential issues
• Follow up on assignments, show initiative, be self-motivated, and have a strong work ethic

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