Case Management Coordinator

Astiva Health, Inc.; Orange (CA); On-site; USD 55,000 - 75,000; Full time

Job summary

Astiva Health, Inc. is seeking a Care Coordinator to support members through case management and care planning, ensuring timely outreach and service delivery. You will verify benefits, coordinate appointments and transportation, and collaborate with providers to coordinate quality care.

The role requires knowledge of healthcare regulations, strong communication skills, and the ability to gather and document information across care teams. Hybrid work options may apply depending on location.

Qualifications

• High School diploma or GED required.
• Minimum of 2 years of experience in healthcare.
• Minimum of 1 year of experience in a healthcare environment.
• Working knowledge of prior authorization, case management principles, and regulations governing Medi-Cal, Medicare, and other programs.
• Medical terminology knowledge.
• Excellent written and verbal communication skills with the ability to build relationships.

Responsibilities

• 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 and specialty providers to provide care to patients.
• Ensure all documentation and communication is complete and updated to 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

Skills

Communication skills

Healthcare terminology

Prior authorization knowledge

Interpersonal skills

Bilingual (preferred)

Education

High School diploma or GED

Job description

Description

• 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 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

Requirements

• 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.