Complex Care Resources Specialist

Neighborhood-Healthcare; Poway (CA); On-site; USD 32,000 - 44,000; Full time

Benefits offered by this job

Medical, Dental and Vision plans (part

Vacation & Holidays

Sick/Personal time

Volunteer Time Off

403b Retirement plan

Job summary

Neighborhood Healthcare is seeking a Complex Care Resource Specialist to coordinate chronic care and SDoH referrals, traveling to NHC sites as needed. You will track referrals, verify insurance, and document actions in medical records per regulations.

Strong communication and organizational skills are essential to support patients and care teams. Travel required to attend meetings and train staff; bilingual abilities are preferred.

Qualifications

• High school diploma/GED.
• CA driver’s license with proof of insurance required for travel.
• One year health-related field experience preferred.
• Bilingual English/Spanish or English/Arabic preferred.

Responsibilities

• Completes thorough referral processes according to standard procedures and protocol to ensure accuracy.
• Tracks all referrals in the designated logs and via eCW.
• Documents all actions taken in patient medical records in accordance with current Clinic, DHS, and health plan regulations/guidelines.
• Discusses all aspects of the referral process provided by the treating provider with patients, including the cost of referral under provider direction.
• Verifies insurance eligibilities and submission of treatment authorizations.
• Administers the SDoH program according to standard procedures and protocols.
• Collaborates and build partnerships with external entities to become familiar with referral sources.
• Maintains accurate lists of specialists/providers by funding source and other community resources as approved by the management.
• Acts as liaison between patients, clinic/providers, specialty care providers, health plans/funding sources, and community resources.
• Impacts patient experiences by demonstrating courteous and helpful behavior and a commitment to accuracy.
• Shares accountability for overall patient health outcomes, working in coordination with care teams.
• Operates to instill confidence in our care and in our facilities to patients, fellow employees, and other stakeholders.
• Attends meetings on and off site when deemed necessary by supervisor.

Skills

Referral coordination

SDoH coordination

Documentation

Communication skills

Multitasking

Planning & organization

Teamwork

HIPAA/compliance

Education

High school diploma/GED

CA Driver's license

Bilingual English/Spanish or English/Arabic preferred

Tools

MS Excel

Databases

eCW

Job description

Community health is about more than just vaccines and checkups. It's about giving people the resources they need to live their best lives. At Neighborhood, this is our vision. A community where everyone is healthy and happy. We're with you every step of the way, with the care you need for each of life's chapters. At Neighborhood, we are Better Together. As a private, non-profit 501(C) (3) community health organization, we serve over 500,000 medical, dental, and behavioral health visits from more than 96k people annually. We do this in pursuit of our mission to improve the health and happiness of the communities we serve by providing quality care to all, regardless of situation or circumstance. We have been doing this since 1969, and it is our employees that make this mission a reality. Regardless of the role, our team focuses on being compassionate, having integrity, being professional, always collaborating, and consistently going above and beyond. If that sounds like an organization you want to be a part of, we would love to have you.

ROLE OVERVIEW and PURPOSE

The Complex Care Resource Specialist works to support the mission and vision of Neighborhood Healthcare by tracking and coordinating patient referrals. The primary responsibilities are coordinating all chronic care and social determinants of health (SDoH) patient referrals and follow-up care for the patients. This position will require travel to NHC sites to attend designated meetings and train selected staff members.

RESPONSIBILITIES

• Completes thorough referral processes according to standard procedures and protocol to ensure accuracy
• Tracks all referrals in the designated logs and via eCW
• Documents all actions taken in patient medical records in accordance with current Clinic, DHS, and health plan regulations/guidelines
• Discusses all aspects of the referral process provided by the treating provider with patients, including the cost of referral under provider direction
• Verifies insurance eligibilities and submission of treatment authorizations
• Administers the SDoH program according to standard procedures and protocols
• Collaborates and build partnerships with external entities to become familiar with referral sources
• Maintains accurate lists of specialists/providers by funding source and other community resources as approved by the management
• Acts as liaison between patients, clinic/providers, specialty care providers, health plans/funding sources, and community resources
• Impacts patient experiences by demonstrating courteous and helpful behavior and a commitment to accuracy
• Shares accountability for overall patient health outcomes, working in coordination with care teams
• Operates to instill confidence in our care and in our facilities to patients, fellow employees, and other stakeholders
• Attends meetings on and off site when deemed necessary by supervisor

EDUCATION/EXPERIENCE

• High school diploma/GED
• Valid California Driver’s license and proof of car insurance required to travel to NHC site for trainings and meetings
• One year health-related field experience preferred
• Bilingual (English/Spanish) or (English/Arabic) preferred

ADDITIONAL QUALIFICATIONS (Knowledge, Skills, and Abilities)

• Excellent verbal and written communication skills, including superior composition, typing, and proofreading skills
• Ability to interpret a variety of instructions in written, oral, diagram, or schedule form
• Knowledgeable about and experience with medical terminology, computer skills, including familiarity with spreadsheets and databases required
• Ability to successfully manage multiple tasks simultaneously
• Excellent planning and organizational ability
• Ability to work as part of a team as well as independently
• Ability to work with highly confidential information in a professional and ethical manner

Physical Requirements

• Ability to lift/carry 25 lbs./weight
• Ability to stand for extended periods of time

COMPLIANCE (Safety & HIPPA)

• Follow all safety procedures as outlined in Neighborhood Healthcare's Illness and Injury Prevention Plan (IIPP) and report any injuries and/or unsafe conditions immediately
• Maintain current knowledge of policies and procedures as they relate to safe work practices
• Follow all safety procedures and report unsafe conditions
• Use appropriate body mechanics to ensure an injury free environment
• Be familiar with location of nearest fire extinguisher and emergency exits
• Follow all infection control procedures including blood-borne pathogen protocols
• Maintain privacy of all patients, employee and volunteer information and access such information only on a need-to-know basis for business purposes
• Comply with all regulations regarding corporate integrity and security obligations
• Report all behavior and/or activity that are unethical, fraudulent, or unlawful

Neighborhood Healthcare offers a generous benefit plan that includes: Partially company paid Medical, Dental, and Vision Plans. Two plus weeks of vacation, Nine Holidays including two Floating Holidays of your choosing, Sick/Personal time, Volunteer Time Off (VTO), 403b Retirement plan (similar to a 401k), optional Health and Wellness events, and much more!

Pay range

$ 22.88 to $32.08 per hour, depending on experience, education and additional qualifications.

Compensation Disclosure

The posted salary range reflects the designated pay grade for this position. While this range represents the broader classification of the role, actual compensation will be based on several factors, including but not limited to: the candidate’s overall knowledge, skills, and experience, market data and industry benchmarks, internal equity within the organization, Budgetary considerations and organizational needs.

Equal Opportunity Employer

This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.