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Referral Case Manager (28 hours/week)

Company: Clinica
Location: boulder
Posted on: May 3, 2021

Job Description:

* Must be bilingual in Spanish and English*

This position is 28 hours/week.

This job exists to: Assure an effective and efficient process is available for patients who need access to specialty care. The Referral Case Manager is 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.


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

A. Education / Experience

1. Bachelor's degree in the human services field preferred, but not required.

2. Or high school/GED and four years in referral processing.

B. Knowledge, skills and abilities:

1. Excellent verbal and written communication skills in English and Spanish required.

2. Ability to flourish independently and in a team management system

3. Sensitivity to low income, ethnic minority community

4. Excellent organizational skills. 5. Excellent tracking, and documentation

6. Excellent attendance

What we offer:

* Competitive Vacation Time * Paid Holidays * Medical Benefits * Dental Benefits * Vision Plan * Retirement Plan * Flexible Spending Account * Growth Opportunities

and more!

Compensation: Approximately $14-$17 per hour. All individual pay rates are calculated based on the candidate's experience and internal equity.

Clinica Family Health is an Equal Opportunity Employer. We prohibit unlawful discrimination against applicants or employees on the basis of age 40 and over, race, color, religion, national origin, sex, disability, sexual orientation, gender identity, or any other applicable status protected by federal, state, or local laws.

Keywords: Clinica, Boulder , Referral Case Manager (28 hours/week), Other , boulder, Colorado

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