Bilingual Referral Case Manager

CFHW; Westminster (CO); On-site; USD 29,000 - 36,000; Full time

Benefits offered by this job

Medical, Dental & Vision options

403(b) Retirement Plan

Vacation, Sick, Personal holidays

Collaborative team environment

Training and growth opportunities

Job summary

Clinica Family Health & Wellness in Westminster, CO is seeking a Referral Coordinator to ensure efficient access to specialty care. You will manage referrals, stay current with Medicaid/Medicare/CHP Plus rules, and provide case management to optimize patient care and outcomes.

You must be bilingual in Spanish and English and hold a Bachelor's degree in human services (or equivalent experience). This on-site role offers comprehensive benefits and a collaborative team environment.

Qualifications

• Bilingual in English and Spanish is required.
• Excellent verbal and written communication skills.
• Strong organizational and documentation abilities.
• Able to work independently and in a team.

Responsibilities

• Process referrals for managed care plans and schedule appointments.
• Maintain up-to-date knowledge of Medicaid/Medicare/CHP Plus rules.
• Provide case management for referrals and chronic diseases.
• Update and monitor referrals per procedure timelines.
• Train staff on changes in referral processes and regulations.

Skills

Bilingual English/Spanish

Organizational skills

Tracking & documentation

Attendance

Education

Bachelor's degree in human services

High school/GED + 4 years in referral processing

Job description

At Clinica Family Health & Wellness, we believe everyone deserves high-quality, compassionate healthcare close to home. We are a nonprofit Federally Qualified Health Center (FQHC) that provides comprehensive, affordable medical, dental, behavioral health, pharmacy, and specialty behavioral care services. We are committed to being a healthcare home for our patients, a place where they receive coordinated, whole-person care from a team that supports their health and well-being at every stage of life.

Overview of Role:

Must be bilingual in Spanish and English.

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

• 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 timeline 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 regard 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, outside customers).
• Request support from professional staff when needed.

POSITION QUALIFICATIONS:

Education and Experience:

1. Bachelor's degree in the human services field preferred.
   1. Or high school/GED and four years in referral processing.

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:

• Comprehensive benefits:
  • Medical, Dental & Vision options
  • Medical and Dependent Care FSA/HSA
  • Company paid life insurance
  • Long term disability insurance
  • Accident/hospital plans
• 403(b) Retirement Plan with employer contributions
• CFWH offers vacation time, sick hours, and personal holiday hours
• A collaborative team environment
• Open communication with leadership and mission-focused engagement
• Training and growth opportunities with a supportive team invested in your success

Compensation: $21.00 - $26.60/hour. The posted range represents the full salary range for this position. Starting pay is based on factors such as directly related experience, education, licensure and/or certification, and internal equity.

Applications for this position will be accepted until the position is filled.

CFHW is committed to aninclusive,age-neutral hiring process. In compliance with the Colorado Job Application Fairness Act (JAFA), we donotask applicants todisclosetheir age, date of birth, or dates of attendance/graduation from an educational institution.Please focus your application on your relevant skills, qualifications, and professional experience.

Clinica Family Health & Wellness is an Equal Employment Opportunity employer. We do not discriminate against any employee or applicant for employment based on race, color, religion, sex, age, national origin, physical or mental disability, sexual orientation, gender identity, genetic information, military status, or any other protected class under applicable federal, state, or local law.

Employees must meet applicable health and safety requirements, including an annual influenza (flu) vaccine,tuberculosis screening at hire, and any position specific requirements. Proof of required immunizations isrequiredbefore employment begins. Exemptions and reasonable accommodations are considered.