Medi-Cal & Medicare Eligibility Navigator

San Ysidro Health; San Diego (CA); On-site; USD 55,000 - 72,000; Full time

Job summary

San Ysidro Health seeks a PACE Eligibility Navigator in San Diego to support enrollment and retention by verifying Medi-Cal and Medicare eligibility. You will collaborate with internal departments, external partners, participants, family members, and state agencies to resolve eligibility issues and ensure timely enrollments.

The role requires knowledge of state and federal health coverage guidelines, data integrity, and compliance.

Qualifications

• High School Diploma or GED or relevant experience.
• Bachelor’s degree in health or human services preferred.
• CA driver’s license with insurance required.
• State trainings (DHCS PACE and Medi‑Cal Marketing) within 60 days of hire.

Responsibilities

• Verify Medi‑Cal and Medicare eligibility for enrollment/retention.
• Assist with new and retroactive enrollments to ensure coverage.
• Maintain accurate data and compliant documentation across systems.
• Collaborate with internal teams and external partners to resolve eligibility issues.
• Prepare and file enrollment/disenrollment requests per guidelines.
• Generate and submit monthly eligibility reports and correspondence.

Skills

Communication skills

Customer service

Bilingual English/Spanish

Education

High School Diploma or GED

Bachelor’s degree in health or human services preferred

Tools

EPIC

CMS

DHCS Provider Portal

Availity

Microsoft Office

Job description

San Ysidro Health seeks a PACE Eligibility Navigator in San Diego to support enrollment and retention by verifying Medi-Cal and Medicare eligibility. You will collaborate with internal departments, external partners, participants, family members, and state agencies to resolve eligibility issues and ensure timely enrollments.

The role requires knowledge of state and federal health coverage guidelines, data integrity, and compliance.