Enrollment & Eligibility Specialist - 2025139

World Relief; Sacramento (CA); On-site; Full time

Job summary

World Relief is seeking an Enrollment & Eligibility Specialist in Sacramento, CA, to support vulnerable populations in accessing health and social services. The role emphasizes client intake, eligibility assessments, and coordination with healthcare providers. Candidates should possess a high school diploma, related experience, and strong organizational and communication skills. This position is crucial for ensuring compliance and accurate documentation within Medi-Cal programs while advocating for clients' needs.

Benefits

Competitive benefits package

Employee discount program

Qualifications

• Minimum 1 year experience in healthcare access or Medi-Cal programs.
• Experience in managing confidential client data and EHR systems.
• Bilingual preferred, with knowledge in languages like Dari, Pashto, Russian, or Spanish.

Responsibilities

• Conduct client intake and eligibility checks for CalAIM services.
• Manage referral processing from various healthcare providers.
• Maintain HIPAA-compliant data and records.

Skills

Organizational skills

Effective communication

Client-focused

Tech-savviness

Education

High school diploma or equivalent

Associate or Bachelor’s degree in health administration, public health, or social work

Tools

Electronic Health Record (EHR) systems

Microsoft Office Suite

Job description

Are you a person of compassion? An advocate for justice? Someone who stands up for the rights of the vulnerable and speaks out for the marginalized, the exploited and the forgotten? Do you believe in our calling as Christians to welcome the least of these and love our neighbor?

If you answered ‘yes’, to any of the above, World Relief, and millions of people around the world need you.

At this pivotal moment in time, we are rapidly expanding and growing our team to meet the increasing needs of our world. We are looking for people who want to use their gifts and talents to make a real and tangible difference in our world and the lives of the suffering.

If you’re looking for a purpose-driven career in which you can grow your talents, while also standing up for the rights of the vulnerable, we want you to join us today.

ORGANIZATION SUMMARY

World Relief is a global Christian humanitarian organization whose mission is to boldly engage the world’s greatest crises in partnership with the church. The organization was founded in the aftermath of World War II to respond to the urgent humanitarian needs of war-torn Europe. Since then, for 80 years, across 100 countries, World Relief has partnered with local churches and communities to build a world where families thrive and communities flourish.

Today, organizational programming focuses on humanitarian and disaster response, community strengthening and resilience, and refugee & immigrant services and advocacy.

This position is reliant upon funding and may be subject to modification or termination based on resource availability.

POSITION SUMMARY:

The Enrollment & Eligibility Specialist plays a vital role in supporting access to health and social services for vulnerable populations, including individuals eligible for Medi-Cal, Enhanced Care Management (ECM), and Community Supports under CalAIM. This role is responsible for assessing client eligibility, facilitating referrals, managing data and documentation, and ensuring accurate, timely, and compliant enrollment processes. The ideal candidate is organized, detail-oriented, client-focused, and experienced in Medi-Cal programs and referral coordination.

ROLE & RESPONSIBILITIES:

• Client Intake & Eligibility Assessment:
• Conduct initial client intake interviews, collecting and documenting personal, medical, and demographic information in accordance with CalAIM and Medi-Cal program requirements.
• Verify client eligibility for CalAIM services, including ECM and Community Supports, ensuring individuals meet all necessary Medi-Cal criteria.
• Perform ongoing checks (e.g., monthly) on Medi-Cal eligibility status to maintain accurate records and ensure clients remain qualified.

• Referral Management & Coordination:
• Receive and process referrals from hospitals, healthcare providers, case managers, and community-based organizations.
• Complete and submit CalAIM referral forms to managed care plans, ensuring all required documentation is included.
• Track referral status and follow up with managed care plans, intermediaries and other World Relief partners to confirm receipt and timely processing.
• Assist with resolving any issues or discrepancies related to referral or eligibility concerns.

• Enrollment Facilitation & Client Engagement:
• Initiate timely contact with referred clients to explain eligibility, program benefits, and next steps for enrollment.
• Schedule and conduct intake appointments and assist with creating and managing client Electronic Health Record (EHR) portal accounts.
• Communicate effectively with clients to gather required documentation, clarify eligibility questions, and provide ongoing updates about their enrollment or referral status.
• Support clients in navigating access to housing services, ECM, and Community Supports as applicable.

• Documentation & Compliance:
• Maintain accurate and up-to-date records of client information, intake forms, eligibility documentation, and referral tracking in an EHR system.
• Ensure all data is handled in compliance with HIPAA regulations and internal confidentiality protocols.
• Generate required reports and contribute to data quality assurance for internal review and funder requirements.

• Collaboration & Program Coordination:
• Work closely with interdisciplinary teams including case managers, care coordinators, behavioral health staff, finance staff and managed care plans to ensure smooth transitions from referral to service enrollment to case discharge.
• Collaborate with external partners and community-based organizations to enhance client access to services.
• Participate in team meetings, trainings, and continuous quality improvement efforts.

JOB REQUIREMENTS:

• Mature and personal Christian faith
• Committed to the mission, vision, and values of World Relief
• Desire to serve and empower the Church to impact vulnerable communities
• Able to affirm and/or acknowledge World Reliefs Core Beliefs, Statement of Faith, Christian Identity and National Evangelicals For the Health of The Nation document
• High school diploma or equivalent required; Associate or Bachelor’s degree in health administration, public health, social work, or a related field with equivalent experience.
• Minimum 1 year of experience working in healthcare access, patient enrollment, case coordination, or a Medi-Cal related program.
• Experience working with Electronic Health Record (EHR) systems and managing confidential client data.
• Knowledge of Medi-Cal eligibility requirements, CalAIM programs, and related state healthcare programs.
• Proficiency in Microsoft Office Suite (Excel, Outlook, Word) and data entry tools.
• Strong organizational skills and the ability to manage high caseloads while meeting deadlines.
• Effective verbal and written communication skills, including comfort with client-facing roles.
• Knowledge of HIPAA and strong commitment to maintaining client privacy and data security.
• Tech-savvy and adaptable to learning new systems and workflows.

PREFERRED QUALIFICATIONS:

• Bilingual or multilingual in a language commonly spoken in the client community (Dari, Pashto, Russian, Ukrainian, Spanish).
• Familiarity with Enhanced Care Management (ECM) and Community Supports under California’s CalAIM initiative.

$27 - $29.50 an hour

World Relief offers a competitive benefits package and employee discount program for full-time and part-time employees.

World Relief is honored to be recognized with the Gold-level Cigna Healthy Workforce Designation for exceeding the core components of our well-being program including leadership and culture, program foundations and execution, and whole person health.

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Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

We are proud to be an EEO/AA employer M/F/D/V. We maintain a drug-free workplace and perform pre-employment substance abuse testing.

For World Relief staff, strong commitment to the mission, vision, and values of World Relief is essential, and Christian faith is a prerequisite for employment, based upon United States federal guidelines provided in Title VII of the Civil Rights Act of 1964.