Conducts outreach and enrollment for prospective members, explains available healthcare and community services, helps with benefits applications, and coordinates warm handoffs into ongoing care management.
Leads Enhanced Care Management across regional teams, overseeing staff, care quality, member services, partnerships, budgets, and program improvements to strengthen outcomes for high-need populations.
Develop and optimize digital and traditional marketing campaigns across social, search, email, and offline channels to grow community engagement and program participation, using analytics to improve reach and conversions.
Maintains accurate, compliant healthcare data by managing health plan submissions, member eligibility and authorizations, system records, operational reporting, and research that supports care delivery and organizational decisions.
Coordinates housing navigation, care management, and community resources for members experiencing housing instability, guiding high-needs caseloads toward stable housing while supporting outreach, advocacy, and compliant documentation.
Coordinates full-cycle recruiting from candidate screening through interview scheduling and pre-boarding, maintaining accurate ATS records, tracking hiring metrics, and supporting a high-touch candidate experience.
Own the end-to-end revenue cycle for Clubhouse Services, preparing compliant bundled-rate claims, verifying eligibility, resolving denials, reconciling payments, and supporting billing workflows and audit readiness.
Leads healthcare revenue cycle operations across billing, claims, accounts receivable, denials, payer reconciliation, and reporting, while supervising staff and driving compliance and measurable performance improvement.
Manage healthcare revenue-cycle billing from claim preparation and coding through denial resolution, reimbursement reconciliation, and reporting, ensuring accurate, timely, and compliant submissions to Medicaid and other payers.
Coordinates Enhanced Care Management for a caseload of approximately 60–70 members, developing care plans, connecting people with health and community resources, and advocating for their needs.
Provides clinical leadership for Enhanced Care Management, guiding interdisciplinary teams, supervising LVNs, reviewing complex cases, and improving coordinated, person-centered care for members with complex medical, behavioral, and social.
Guide prospective members through Medi-Cal applications, renewals, eligibility issues, appeals, and managed care enrollment, tracking each case through coverage approval and readiness for program services.
Oversee administrative assistant and data administration functions, supervising assigned staff, improving workflows, maintaining data quality, and coordinating compliance reporting and cross-department deliverables.
Provides therapy, crisis intervention, assessments, and case management while developing treatment plans and coordinating care with clinical and ECM teams to support clients’ mental health and recovery goals.
Supports high-risk Medi-Cal members through clinical assessments, care coordination, medication reconciliation, health education, outreach, and transitions of care in collaboration with an interdisciplinary ECM team.
Provides therapy and crisis support through in-person and telehealth services, conducting assessments, developing treatment plans, coordinating referrals and case management, and collaborating with the Enhanced Care Management team.
Provides clinical leadership for CalAIM Enhanced Care Management, guiding interdisciplinary teams, supervising LVNs, and improving coordinated, person-centered care for members with complex medical, behavioral health, and social needs.
Department: Enhanced Care Management (ECM) Reports To: Registered Nurse Clinical Case Consultant Classification: Non-Exempt Work Arrangement: Hybrid – Hiring County Compensation: $30.00 - $35.00 per hour Schedule:.
Provide therapy and crisis support through in-person and telehealth care, conducting assessments, developing treatment plans, coordinating referrals and case management, and collaborating with the Enhanced Care Management team.
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