Bilingual Referral Case Manager

At Clinica Family Health & Wellness, we believe everyone deserves high-quality, compassionate healthcare close to home. We are a nonprofit Federally Qualified Health Center (FQHC) that provides comprehensive, affordable medical, dental, behavioral health, pharmacy, and specialty behavioral care services. We are committed to being a healthcare home for our patients, a place where they receive coordinated, whole-person care from a team that supports their health and well-being at every stage of life.

*Must be bilingual in Spanish and English.*

You will assure an effective and efficient process is available for patients who need access to specialty care. You will be responsible for maintaining up to date knowledge of the managed care referrals process, specialty programs, and state rules and regulations for Medicaid, Medicare, and CHP Plus. There will also be the opportunity to assist with organizational development to maintain an effective referral process, ensure proper data collection, and create necessary reports.

• →Process referrals for managed care plans, specialty programs such as CCHN, to receive authorization and schedule needed appointments.
• →Maintains up to date knowledge of managed care referrals process, specialty programs and state rules and regulations for Medicaid, Medicare and CHP Plus.
• →Provides case management services to assure all needed information is obtained to facilitate an effective referral.
• →Provides case management for all chronic diseases and preventative programs as requested.
• →Updates and monitors all referrals being tracked per the timeline specified in the referral procedure.
• →Communicates with providers regarding pending referrals and issues pertaining to processing requested referrals
• →Collects data and writes reports as requested.
• →Assist with organizational development to maintain an effective referral process.
• →Provides information/training to the clinic staff in regard to changes in referral process, change in no payer source referral, and state rules and regulation changes.
• →Will work at another site as deemed necessary by the Clinic Director.
• →Provides superb customer service to all customers (coworkers, outside customers).
• →Request support from professional staff when needed.

1. Bachelor’s degree in the human services field preferred.
   1. Or high school/GED and four years in referral processing.

1. Excellent verbal and written communication skills in English and Spanish required.
2. Ability to flourish independently and in a team management system.
3. Sensitivity to low income, ethnic minority community.
4. Excellent organizational skills.
5. Excellent tracking, and documentation.
6. Excellent attendance