Job Details

About Us: Astiva Health, Inc., located in Orange, CA is a premier healthcare provider specializing in Medicare and HMO services. With a focus on delivering comprehensive care tailored to the needs of our diverse community, we prioritize accessibility, affordability, and quality in all aspects of our services. Join us in our mission to transform healthcare delivery and make a meaningful difference in the lives of our members.

SUMMARY: The Case Management Coordinator is responsible for gathering all relevant information for the identified member population during assessment, care planning, interdisciplinary care team meetings, and transitions of care. The Coordination performs troubleshooting when problem situations arise and takes independent action to resolve complex care issues.

ESSENTIAL DUTIES AND RESPONSIBILITIES include the following:

• Accurately enter confidential data into the case management system to ensure timely care coordination and outreach.
• Verify member benefits and eligibility upon receipt of care coordination or case management.
• Utilize DOFR or delegation agreements to drive decision making.
• Coordinate and assist with patient appointments, transportation or utilize community resources.
• Gather relevant information for the identified member population during assessment, care planning, interdisciplinary care team meetings, and transition of care.
• Complete applicable patient assessments in a timely manner.
• Coordinate with case manager to actively problem solve for patients.
• Proactively outreach to patients to verify that needs are being met and services are being satisfactorily delivered.
• Intervene at the client level to coordinate the delivery of direct services to clients and their families.
• Coordinate with primary can specialty providers to provide care to patients.
• Ensure all documentation and communication is complete and updated to
• Astiva Health, Inc. partners at the IPA or MSO level and all clinical teams are updated to authorize
• patient services.
• Review all available community resources prior to requesting patient services for use and authorization.
• Serve as a resource for patients, providers, internal teams and external customers regarding plan policies, benefits, and care coordination.
• Support the Utilization Management department by uploading member admission, home health and skilled nursing facility admissions. Collaborate with department leadership to coordinate calendars for meetings and coordinate interdisciplinary team communications.
• Serve as the Outreach Liaison between the IPA/MSO's for all delegation reports and communications.
• Regular and consistent attendance
• Other duties as assigned

EDUCATION and/or EXPERIENCE:

• High School diploma or GED required.
• Minimum of 2 years of experience working in the healthcare industry.
• Minimum of 1 year of prior experience working, training, or education within a healthcare environment.
• Strong working knowledge of prior authorization, case management principals, and regulations governing Medi-Cal, Medicare, and other government and commercial healthcare programs.
• Working knowledge or medical terminology.
• Excellent written and verbal communication skills with the ability to build and foster strong interpersonal relationships.
• Bilingual in a second language preferred.

BENEFITS:

• 401(k)
• Dental Insurance
• Health Insurance
• Life Insurance
• Vision Insurance
• Paid Time Off
• Free catered lunches