Remote Care Coordinator, Transition of Care, Bilingual Spanish

Alignment Health; United States; On-site; USD 41,000 - 62,000; Full time

Job summary

Alignment Health seeks a Care Coordinator to support SNP members as part of an interdisciplinary team led by the RN Case Manager. You will handle referrals, authorizations, and care coordination tasks, ensuring timely assessments and documentation.

The role emphasizes strong communication with members and PCPs, maintaining records, and meeting deadlines while protecting patient confidentiality within a fast-paced environment.

Qualifications

• Experience in Health Care IPAs and entering referrals and prior authorizations.
• High School Diploma or GED required; Bachelor’s degree or four years additional experience acceptable in lieu of education.
• MBA preferred.
• Medical Assistant training and Medical Terminology training are beneficial.

Responsibilities

• Reach out to members by phone to assist with referrals, authorizations, home health care, DME, medications, and appointments.
• Create cases and tasks; complete assessments for hospital and SNF discharges.
• Maintain member records and coordinate with the interdisciplinary team.
• Escalate concerns to the nurse when changes in condition occur; act as patient advocate.

Skills

Bilingual English/Spanish

Communication skills

Customer service

Time management

Problem solving

Microsoft Outlook

Excel

Word

Managed Care Plans

Medi-Cal knowledge

Education

High School Diploma or GED

Bachelor’s degree or equivalent experience

MBA

Tools

Case Management system

Microsoft Outlook

Excel

Word

Job description

Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together.

The Care Coordinator works in collaboration with the RN Case Manager as part of the interdisciplinary team. The Care Coordinator supports members with closing care gaps and addressing care coordination needs as directed by the RN Case Manager. The Special Needs Plan (SNP) team is responsible for the health care management and coordination of care for members with complex and chronic care needs.

General Duties/Responsibilities (may Include But Are Not Limited To)

• Reaches out to members telephonically to assist with referrals, authorizations, HHC, DME needs, medication refills, make provider appointments and follow ups, etc.
• Creates cases, tasks, and completes assessments in Case Management module for all Hospital and SNF discharges
• Complies with tasks assigned by nurse and, as appropriate, documents accordingly
• Works as a team with the Case Manager to engage and manage a panel of SNP members
• Manages new alerts and updates Case Manager of change in condition, admission, discharge, or new diagnosis
• Establishes relationships with members, earns their trust and acts as patient advocate
• Escalates concerns to nurse if members appear to be non-compliant or there appears to be a change in condition
• Assists with outreach activities to members in all levels of Case Management Programs.
• Assists with maintaining and updating member’s records
• Assists with mailing or faxing correspondence to members, PCP’s, and/or Specialists
• Requests and uploads medical records from PCP’s, Specialists, Hospitals, etc., as needed
• Attends Interdisciplinary Team Meetings and participates in member presentations as appropriate.
• Meets specific deadlines (responds to various workloads by assigning task priorities according to department policies, standards and needs)
• Maintains confidentiality of information between and among health care professionals
• Other duties as assigned by CM Supervisor, Manager or Director of Care Management

Experience

Job Requirements

• Required: Minimum 1 year experience working in Health Care IPAs. Minimum 1 year experience entering referrals and prior authorizations.
• Preferred:

Education

• Required: High School Diploma or GED. Bachelor's degree or four years additional experience in lieu of education.
• Preferred: MBA

Training

• Required:
• Preferred: Medical Assistant training, Medical Terminology training.

Specialized Skills

• Required:
• Ability to read and interpret documents such as safety rules, operating and maintenance instructions and procedure manuals. Ability to write routine reports and correspondence. Communicates effectively using good customer relations skills.
• Ability to communicate positively, professionally and effectively with others; provide leadership, teach and collaborate with others.
• Problem-Solving Skills: Effective problem solving, organizational and time management skills and ability to work in a fast-paced environment.
• Knowledge of Managed Care Plans
• Knowledge of Medi-Cal
• Basic Computer Skills, 25 WPM (Microsoft Outlook, excel, word)
• Mathematical Skills: Ability to add and subtract two digit numbers and to multiply and divide with 10’s and 100’s. Ability to perform these operations using units of American money and weight measurement, volume, and distance.
• Reasoning Skills: Ability to apply common sense understanding to carry out detailed but uninvolved written or oral instructions. Ability to deal with problems involving a few concrete variables in standardized situations.
• Bilingual (English/Spanish),

Licensure

• Required: None
• Preferred: Medical Assistant Certificate, Medical Terminology Certificate

Essential Physical Functions

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.
• The employee frequently lifts and/or moves up to 10 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.

Work Environment

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Pay Range: $41,472.00 - $62,208.00

Pay range may be based on a number of factors including market location, education, responsibilities, experience, etc.

Alignment Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity, or sexual orientation.