Duties & Responsibilities:


85% - Program Support Under general direction, supports with processing routine WCM referrals, AMRs, and ICTs within appropriate timeframes for all CalOptima Health members. Collaborates with health networks to ensure timely receipt of members' clinical information. Coordinates with OCHCA CCS to address health networks need for necessary clinical information. Works with Case Management staff, OCHCA CCS and other members of the health care team to facilitate medical care and expedite the resolution of member concerns. Performs outreach to members to coordinate the completion of the initial and annual HNA or HRA. Reviews member concerns or questions that could potentially require additional support or outreach with the Supervisor. Facilitates communication of initial care plan to the primary care provider (PCP), health network and member, as needed. Facilitates referrals to behavioral health services. Identifies member needs and assists members with referrals to community resources to meet those needs. Guides members in understanding and accessing the benefits they are entitled to under Medi-Cal and CCS. Notifies the member's care team of key event triggers.


10% - Administrative Support Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability. Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department. Maintains documentation of the member's case, care plan and interdisciplinary care team within CalOptima Health's medical management system.


5% - Completes other projects and duties as assigned.


Minimum Qualifications:


High School diploma or equivalent required.


1 year of experience working with the needs of pediatric members in a member service capacity required.


An equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying.


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, and Los Angeles County Fair Chance Ordinance. For unincorporated Los Angeles county, to the extent our customers require a background check for certain positions, the Company faces a significant risk to its business operations and business reputation unless a review of criminal history is conducted for those specific job positions.