Medicare Case Manager Jobs in Riverside, CA (NOW HIRING)

The Case Manager provides comprehensive non-clinical support, guidance, and assistance for patients and their families as they navigate the health care system and help overcome barriers that prevent them from getting the care they need. The goal of case management is to help HFHC patients get the health care and other resources they need to be as healthy as possible through comprehensive assessment of needs, development of a care plan, provision of intensive case management services, use of therapeutic interactions to promote healthy behaviors, coordination of care, and resource linkages as needed. Assesses Social Determinants of Health (SDOH) and provides supports, coordination, warm hand-offs and internal and community linkages to address barriers to care. Additionally, this role is responsible for outreaching and enrolling clients in enhanced care management and will work collaboratively with and as a part of the community programs interdisciplinary team to provide high quality, effective case management to HFHC members. This position will focus on the Enhanced Care Management (ECM) populations as well as Substance Use Disorder (SUD) and Medically Assisted Treatment (MAT) populations.

This position is full-time with a schedule of Monday through Friday 8am to 5pm.

All applicants must be bilingual in Spanish and English.

What You'll Do:

Job Responsibilities & Duties

• Manages and coordinates care for a defined caseload of Enhanced Care Management Cal Optima members with complex needs.
• Supports HFHC’s Addiction Medicine program with case management services.
• Screens and assists patients with Medi-Cal, Medicare, Covered California, and other programs redetermination and enrollment. Additionally, determine patient eligibility for other programs and services (i.e. Cal-Fresh, etc.). Provide follow-up to ensure completion of enrollment.
• Screens for other barriers to care such as transportation, housing, food, etc. and assist patient with appropriate referral to social service agencies.
• Actively participates in the integrated care team setting by consulting and collaborating with all other service departments and staff including but not limited to Primary Care, Addiction Medicine, etc.
• Assures that patient eligibility is verified before any appointments.
• Conducts outreach and education to patients regarding public benefits and services such as public insurance, county uninsured programs, and Medi-Cal.
• Displays knowledge of all HFHC uninsured programs including the Sliding Fee Scale program.
• Determines patients’ eligibility for appropriate programs and services and provide and promote health education to individuals and groups.
• Conducts outreach, enrollment, and case management to selected population of focus determined by assigned health plan and facility and enroll member in ECM.
• Develops an individualized comprehensive management care plan integrating clinical and non-clinical needs to achieve health goals designed to improve functional status, health status, or prevent decline.
• Engages with members both in person and on the phone in a manner that utilizes evidence-based approaches, such as MI, that promote collaboration between the member and their health.
• Assists with the coordination of healthcare access issues.
• Utilizes brief behavioral health therapeutic interventions as necessary to improve the member’s ability to manage their own mental health concerns and symptoms.
• Maintains documentation for each contact as instructed and within the program timelines (weekly, monthly, quarterly).
• Develops relationships with outside organizations and individuals for the ECM program.
• Displays knowledge of other services offered at HFHC.
• Promotes HFHC’s mission by outreaching, screening, educating and when eligible, enrolling patients in getting maximum financial coverage for their health care services through public assistant, health center discount programs, county uninsured programs, Covered California, and other programs so that they can received care at no or fees in proportions to their ability to pay.
• Coordinates and participates special events, health fairs, and community related activities.
• Provides reports to HFHC leadership and ensures that HFHC meets financial and grant goals.
• Provides data-drive reports to HFHC leadership.
• Attends and participates in meetings and training sessions as directed by supervisor.
• Contacts potential patients for enrollment and assist patients with completing forms.
• Makes referrals and provides follow-up to appropriate community or state resources to ensure services are received.
• Makes recommendations to admin for enrollment activities and new patient orientation.
• Participates in ensuring quality care delivery through enhancing patient experience, improving clinical experience, improving population health, and reducing costs.
• Lead patient access and efficiency by modeling high effectiveness, training, and assisting other providers in maximizing time and access to care. This includes providing feedback to admin and provider mentorship.
• Participates in staff and educational meetings.
• Maintains the privacy and security of protected health information, the confidentiality of all information and conducts all aspects of patient care in an ethical and professional manner in accordance with federal, state rules and regulations.
• Maintains a clean, safe and unobstructed workplace.
• Performs other job duties as requested by the supervisor.

These duties are not exclusive and with consideration of the job requirements and employee skills, this job description can be added to or taken away from at the discretion of the employee’s immediate supervisor.

What You'll Bring:

Minimum Qualifications

Minimum Position Qualifications:

• Education: High School Diploma or equivalent.
• Bilingual in Spanish and English.

Preferred Position Qualifications:

• Certified Enrollment Counselor by the State of California.
• Good understanding regarding eligibility requirements and enrollment for public assistance programs and county programs e.g. Medicaid, Medicare, and third-party insurance.
• Good understanding of medical terminology
• Help eligibility screening and enrollment activities for Hurtt patients, including identifying and enrolling patients who are eligible for Medi-Cal, Medicare, Medicaid, and other programs.
• Current Basic Cardiac Life Support (BCLS) certification for infants and adults.
• Familiar with Orange County area, resources, and services is preferred but not required.
• Excellent computer skills with Microsoft Word, Microsoft Excel, internet required; experience working with Medical management software system is plus.
• Proven reliability, trustworthiness, flexibility and high ethical standards.
• Highly self-motivated, action-oriented and customer-services driven.
• A pleasant personality to all people you are speaking with.
• Familiar with health systems and community resources.
• Regular timely attendance on the job.