Referral Case Specialist
Job Type
Full-time
Description

General Summary:

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


Summary of Essential Duties: (*Essential Functions)

  • Provides day-to-day care coordination activities and referral follow-up
  • Processes referrals on daily basis
  • Follows up on referrals
  • Follows up on all specialist’s reports for medical providers 
  • Conducts  culturally appropriate Multi-Component Care Plans and update as need on a quarterly basis
  • Participates n 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

Job Specifications: (Knowledge, skills, abilities and experience normally required for competent performance)


Education and Knowledge

  • High School Diploma or equivalent required
  • AA  Degree, preferred
  • Demonstrate knowledge of safety, infection control & emergency policies and procedures

Experience

  • Must have minimum 2 -3 years in medical setting 
  • Understanding of medical terminology- familiar with Medicare, Medi-cal, etc.

 Skills and Abilities

  • Good written, oral and customer service skills
  • Bilingual/Bi literate Spanish/English Required

Licensure and Certificates:

  • Current California LVN license
  • BLS Certificate