Supports the coordination, authorization, documentation, and delivery of community-based support services. Reviews eligibility, facilitates referrals and enrollments, coordinates with internal teams and providers, maintains accurate records, and helps ensure compliance with applicable regulations.
Responsibilities
Review community support screening documents to determine member eligibility.
Follow up with internal staff and providers to support referrals and member enrollment.
Process daily service authorizations and denials for requested services.
Complete data entry, tracking, and case documentation, including enrollment status, authorizations, encounter data, care coordination activities, clinical records, and regulatory reports.
Assist with reconciling provider invoices and claims.
Communicate with service providers to support the timely submission of deliverables and reports.
Assist with training internal teams, external providers, and community-based organizations on available services and referral processes.
Review provider reports for accurate data collection and reporting.
Respond to inquiries regarding the status of service authorization requests.
Participate in multidisciplinary team meetings to coordinate member care and support continued engagement in services.
Conduct outreach calls to members, as needed, to verify participation in services.
Identify and help address gaps and barriers in the care coordination process.
Support compliance with applicable state and federal rules and regulations.
Perform other assigned duties as required.
Requirements
High school diploma or equivalent.
Experience working with electronic medical record systems.
Experience with data entry, utilization management, care coordination, or related administrative processes.
Proficiency with Microsoft Word, Excel, Outlook, and Teams.
Ability to maintain accurate documentation and manage multiple priorities.
Skill
Strong attention to detail.
Excellent written and verbal communication.
Organization and time-management skills.
Data entry and documentation accuracy.
Ability to collaborate effectively with providers, internal teams, and community organizations.
Knowledge of health plans, public health programs, or Medi-Cal is preferred.
Summary Qualification
Experience supporting healthcare, social services, care management, or community-based programs.
Ability to review eligibility information and process service authorizations.
Understanding of care coordination, member outreach, and service referral processes.
Ability to analyze reports, identify data gaps, and support accurate regulatory reporting.
Compassionate interest in improving access to social and healthcare services.
Wollborg Michelson Recruiting is an Equal Opportunity Employer and prohibits discrimination of any kind. We ensure job offers are made based of one s employment experience, skills, and qualifications, regardless of race, gender, ethnic origin, or any other classification protected by law. All applicants must furnish proper identification to prove their legal right to work in the US upon a job offer. We participate in E-Verify to confirm one s right to work in the US. Wollborg Michelson Recruiting does not provide sponsorship for an employment-based visa status.
Numbers & Facts
Location
Rancho Cordova, CA
Skills
Analysis Skillsunmatched
Billingunmatched
Clinical Supportunmatched
Community Programsunmatched
Community Supportunmatched
Community and Social Servicesunmatched
Cross-Functionalunmatched
Customer Support/Serviceunmatched
Data Collectionunmatched
Data Entryunmatched
Detail Orientedunmatched
Documentationunmatched
Electronic Medical Recordsunmatched
Federal Laws and Regulationsunmatched
Health Planunmatched
Healthcareunmatched
High School Diplomaunmatched
Legalunmatched
Maintain Complianceunmatched
Medi-Calunmatched
Medical Record Systemunmatched
Medical Recordsunmatched
Microsoft Excelunmatched
Microsoft Outlookunmatched
Microsoft Wordunmatched
Multitaskingunmatched
Organizational Skillsunmatched
Presentation/Verbal Skillsunmatched
Process Managementunmatched
Public Healthunmatched
Record Keepingunmatched
Regulatory Complianceunmatched
Regulatory Reportsunmatched
Reporting Skillsunmatched
Social Workunmatched
State Laws and Regulationsunmatched
Support Documentationunmatched
Team Playerunmatched
Time Managementunmatched
Utilization Managementunmatched
Writing Skillsunmatched
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