Qureos Mentor

Clinica Family Health & Wellness

<div><h4 class="jobSectionHeader">What we offer:</h4>
<ul><li>Comprehensive Benefits:
<ul><li>Medical</li>
<li>Dental</li>
<li>Vision</li>
<li>FSA/HSA</li>
<li>Life and Disability</li>
<li>Accident/Hospital Plans</li>
<li>Retirement with Employer Contributions</li>
</ul></li><li>Vacation, sick, and extended illness time off options</li>
<li>Open communication with leadership and mission-focused engagement</li>
<li>Training and growth opportunities with a supportive team invested in your success</li>
</ul>
Compensation: Approximately $21.00 - $26.60 per hour. All individual pay rates are calculated based on the candidate's experience and internal equity.
<h4 class="jobSectionHeader">
Overview of Role:</h4>

*Must be bilingual in Spanish and English.* 
**Combined position that is both Medical Records and Referral Case Manager**

You will assure an effective and efficient process is available for patients who need access to specialty care. You will be 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.

ESSENTIAL DUTIES AND RESPONSIBILITIES:
<ul>
<li>Process referrals for managed care plans, specialty programs such as CCHN, to receive authorization and schedule needed appointments.</li>
<li>Maintains up to date knowledge of managed care referrals process, specialty programs and state rules and regulations for Medicaid, Medicare and CHP Plus.</li>
<li>Provides case management services to assure all needed information is obtained to facilitate an effective referral.</li>
<li>Provides case management for all chronic diseases and preventative programs as requested.</li>
<li>Updates and monitors all referrals being tracked per the time line specified in the referral procedure.</li>
<li>Communicates with providers regarding pending referrals and issues pertaining to processing requested referrals</li>
<li>Collects data and writes reports as requested.</li>
<li>Assist with organizational development to maintain an effective referral process.</li>
<li>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.</li>
<li>Will work at another site as deemed necessary by the Clinic Director.</li>
<li>Provides superb customer service to all customers (coworkers, out side customers).</li>
<li>Request support from professional staff when needed.</li>
</ul>
POSITION QUALIFICATIONS:

Education and Experience:
<div>
<ul><li>Bachelor&rsquo;s degree in the human services field desired.</li></ul>
<ul><li>Or high school diploma/GED and four years in referral processing.</li></ul>
</div>
Knowledge, Skills and Abilities:
<div>
<ul><li>Excellent verbal and written communication skills in English and Spanish required.</li></ul>
<ul><li>Ability to flourish independently and in a team management system.</li></ul>
<ul><li>Sensitivity to low income, ethnic minority community.</li></ul>
<ul><li>Excellent organizational skills.</li></ul>
<ul><li>Excellent tracking, and documentation.</li></ul>
<ul><li>Excellent attendance.</li></ul>
</div>
We are committed to equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender, gender identity or expression, or veteran status. We are proud to be an equal opportunity workplace.</div>

Bilingual Referral Case Manager & Medical Records Clerk

Join Clinica Family Health & Wellness and explore 1   exciting career opportunities. They're hiring for various roles with options for remote or on-site work. Apply today and become part of their innovative team.

Clinica Family Health & Wellness

About Company

Bilingual Referral Case Manager & Medical Records Clerk