NEMT Care Coordinator

Partnership HealthPlan of California; Redding (CA); On-site; USD 39,000 - 46,000; Full time

Job summary

Partnership HealthPlan of California is seeking a Care Coordination professional to facilitate access to medical care by coordinating Non-Emergency Medical Transportation and travel-related benefits for members.

Responsibilities include communicating with members and providers, coordinating transports under DHCS guidelines, resolving issues, and maintaining accurate documentation while ensuring compliance with policies and procedures.

Qualifications

• High School diploma or equivalent required.
• One year experience in medical/clerical field or equivalent combination.
• Experience in phone-based customer service preferred.

Responsibilities

• Communicate effectively with members and providers (written and verbal).
• Coordinate transports and travel-related services per DHCS guidelines and policies.
• Resolve or escalate issues in a timely manner.
• Manage member and provider complaints and grievances.
• Notify clinical staff of urgent health issues and assist as needed.
• Escalate non-transportation needs to appropriate teams.
• Build effective relationships with health plan staff and external partners.
• Verify member eligibility and program benefits.
• Validate drop-off/pick-up locations for Medi-Cal compliance; identify fraud risks.
• Obtain necessary medical information from providers for care level determinations.
• Contact providers to obtain information for authorizations.
• Generate administrative denial letters per policy.
• Document all transportation cases in the system.
• Route calls from the transportation call center courteous and professionally.

Skills

Oral communication

Problem solving

Managed care knowledge

Teamwork

Organizational skills

Telephone system

Data entry

Bilingual (Spanish/Tagalog/Russian)

Education

High School diploma or equivalent

Tools

ACD phone system

Computer data entry

Job description

Partnership HealthPlan of California is seeking a Care Coordination professional to facilitate access to medical care by coordinating Non-Emergency Medical Transportation and travel-related benefits for members.

Responsibilities include communicating with members and providers, coordinating transports under DHCS guidelines, resolving issues, and maintaining accurate documentation while ensuring compliance with policies and procedures.