Bilingual Spanish Care Coordinator, Special Needs Program at Alignment Healthcare USA, LLC in Orange, California

Job Description:

Overview of the Role:

Alignment Health is seeking a bilingual Spanish remote care coordinator to join the special needs plan (SNP) case management team. The SNP team is responsible for the health care management and coordination of care for members with complex and chronic care needs. As a care coordinator, will be responsible for case management coordinator functions for the SNP membership and get to support members with closing care gaps and addressing care coordination needs as directed by the RN Case Manager. You will collaborate with the RN case manager as part of the interdisciplinary team.

Responsibilities:

• Reach out to members telephonically to assist with referrals, authorizations, HHC, DME needs, medication refills, make provider appointments and follow ups, etc
• Create cases, task, and complete assessments in case management module for all hospital and SNF discharges
• Complete and document tasks assigned by case manager.
• Work as a team with the case manager to engage and manage a panel of SNP members
• Manage new alerts and update case manager of change in condition, admission, discharge, or new diagnosis
• Establish relationships with members, earn their trust, and act as patient advocate
• Escalate concerns to nurse if members appear to be non-compliant or there appears to be a change in condition
• Assist with outreach activities to members in all levels of case management programs.
• Assist with maintaining and updating member's records
• Assist with mailing or faxing correspondence to members, PCP's, and/or Specialists
• Request and upload medical records from PCP's, Specialists, Hospitals, etc., as needed
• Attend interdisciplinary team meetings and participate in member presentations as appropriate.
• Meet specific deadlines (respond to various workloads by assigning task priorities according to department policies, standards and needs)
• Maintain confidentiality of information between and among health care professionals

1. Experience working with IPAs
2. Experience entering referrals and prior authorizations
3. Experience with Access Express / Portal, Epic, Essette preferred
4. Knowledge of Managed Care Plans
5. Knowledge of Medi-Cal
6. High school diploma or general education degree (GED); with one to three months related experience and / or training; or equivalent combination of education and experience
7. Medical Assistant Certificate Preferred
8. Medical Terminology Certificate preferred
9. Organized and detail oriented
10. Proficient computer skills, 25 WPM (Microsoft Outlook, Excel, Word)
11. Read, write, and speak English fluently
12. Bilingual English / Spanish highly preferred
13. Good interpersonal skills
14. Good verbal, written, and telephonic skills
15. Able to read and interpret documents such as safety rules, operating and maintenance instructions and procedure manuals. Able to write routine reports and correspondence. Communicates effectively using good customer relations skills. Able to file systematically
16. Able to add and subtract two-digit numbers and to multiply and divide with 10's and 100's. Able to perform these operations using units of American money and weight measurement, volume, and distance.
17. Able to apply common sense understanding to carry out detailed but uninvolved written or verbal instructions. Able to deal with problems involving a few concrete variables in standardized situations. Able to reason and carry out instructions.