Referral Case Specialist
Job Type
Full-time
Description

Title: Referral Case Specialist 

Base Salary Range: $37,440 - $43,179 plus benefits

FTE: Full-time, Non-Exempt


Company intro: South Central Family Health Center (SCFHC) is a primary health care clinic that has been committed to providing quality health care for uninsured families and individuals for more than 37 years. Seeks passionate individuals to join our team.


Our Mission: The Mission of South Central Family Health Center is to improve the quality of life for the diverse Community of inner city Los Angeles by providing affordable and comprehensive health care and education in a welcoming and multi-cultural environment. 

To lead the way in health care in South Los Angeles, as the premier provider and employer of choice offering comprehensive, high quality, affordable, efficient and culturally responsive services.


Responsibilities:  The Referral Case Specialist will be responsible for processing referral requests from various sources to ensure compliance with federal, state, or Health Plan specific requirements. The referral specialist is accountable for facilitating timely authorizations and notifications as well as other referral management functions. This position works closely providing support to a clinical team in order to facilitate the administrative components of clinical referrals for various services.

  • Provides day-to-day care coordination activities and referral follow-up
  • Processes referrals on daily basis
  • Follows up on referrals
  • Research referrals and verifies information and ensure the prior authorization request is processed accurately.
  • Follows up on all specialist’s reports for medical providers.
  • Initiates and manages clinical referrals for pre-authorization.
  • Act as a liaison between the primary care provider patients, specialists, and health plans 
  • Verifies insurance coverage and completes pre-authorization following established process and procedures.
  • Conducts culturally appropriate Multi-Component Care Plans and update as need on a quarterly basis
  • Participates in case conferences and provide input related to care issues.
  • Provides case management.
  • Develops and implement a client-centered proactive Care Model
  • Assists in the development and implementation of a web-based Management Information System.
  • Implements quality improvement and evaluation activities
Requirements

Top benefits or perks: As a team member at South Central Family Health Center, you’ll enjoy competitive wages and generous benefits:

  • Benefits: Health care, dental, life insurance
  • 403 (b) Retirement plan
  • Education Reimbursement
  • Career development: Entry-level employees have opportunities to work in management, HR or other areas of the company 

Qualifications:

  • High School Diploma or equivalent required
  • AA Degree, preferred
  • Medical Assistant Diploma/Certificate (Preferred)
  • Current BLS Certification required.