Public Programs Specialist

Centene Corp.; California (MO); Hybrid; USD 32,000 - 55,000; Full time

Job summary

Health Net seeks a Public Programs Specialist to triage member access to care issues and coordinate services with California-based public programs. The role is remote for California residents, with standard 8–hour PST workdays.

Preferred candidates have 3+ years of pediatric clinical experience and current California Medical Assistant Certification, LVN, or Pharmacy Technician Certification. Collaboration across departments is essential to improve access to care.

Qualifications

• Minimum three years of combined clinical and healthcare experience.
• Current, valid and unrestricted California Medical Assistant Certification, or LVN license or Pharmacy Technician Certification preferred.

Responsibilities

• Triages and resolves member access to care issues.
• Coordinates services with programs carved out of the health plan contract.
• Collaborates with internal departments to resolve member issues.
• Serves as liaison to public agency programs and assists with referrals to HEL P program.
• Researches and resolves coordination of care referrals from Customer Services.
• Performs escalation and monitors cases through resolution.
• Supports Regional Centers, School Health Integration and California Children’s Services.
• Prepares and submits reports to compliance.

Skills

Coordination of care

Referral management

Escalation handling

Documentation

Communication

Education

Associate’s degree

Vocational Nursing

Medical Assisting

Pharmacy Technician Program

Job description

## Public Programs SpecialistApply: Remote-CA: Full time: Posted Today: 1658014**Position Purpose:** The Public Programs Coordinator is responsible for triaging and resolving member access to care issues and coordinating services with programs that are \"carved out\" of the health plan contract with the Department of Health Care Services, i.e. California Children's Services and Regional Centers, as well as, promoting member access to Health Net's Empower Living Program (H.E.L.P.) This position is also responsible for communicating and collaborating with internal and external customers to ensure access to care and services for Health Net members.**Key Details:** Applicants for this role will have the flexibility to work remotely from their home anywhere in the State of California. Standard Hours are Monday - Friday 8AM to 5PM PST. Current, valid and unrestricted California Medical Assistant Certification and 3+ years Pediatrics Experience highly preferred.* Researches, resolves, makes referrals and follows up with clients and agencies for access to care issues.* Collaborates with multiple Health Net Departments including, but not limited to, Member Services, Provider Network Management, Medical Management, Medical Review Unit, Pharmacy and Claims to resolve member issues.* Serves as Health Net’s liaison to public agency programs and assists with referrals from the Participating Physician Groups (PPG) to the H.E.L.P Program.* Receives, researches and resolves coordination of care referrals from Customer Services.* Conducts escalated service coordination on complex cases and monitors through resolution.* Supports programs such as Regional Centers, School Health Integration and California Children’s Services with in-person meetings to better understand and promote available services.* Researches and prepares conflict resolution documentation to support Appeals and Grievances.* Prepares and submits monthly and quarterly COC reports to compliance.* Performs other duties as assigned.* Complies with all policies and standards**Education/Experience:** Associate’s degree, completion of Vocational Nursing School, Medical Assisting or Pharmacy Technician Program. Minimum three years of combined clinical and healthcare experience. **License/Certification:** Current, valid and unrestricted California Medical Assistant Certification, or current, valid and unrestricted Licensed Vocational Nurse (LVN) license or current, valid and unrestricted Pharmacy Technician Certification preferred **Government Security/Clearance/Citizenship Requirements:**Pay Range: $23.23 - $39.61 per hour