Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together.

GENERAL DUTIES/RESPONSIBILITIES (MAY INCLUDE BUT ARE NOT LIMITED TO):
1.    Reaches out to members telephonically to assist with referrals, authorizations, HHC, DME needs, medication refills, make provider appointments and follow ups, etc.
2.    Creates cases, tasks, and completes assessments in Case Management module for all Hospital and SNF discharges
3.    Complies with tasks assigned by nurse and, as appropriate, documents accordingly
4.    Works as a team with the Case Manager to engage and manage a panel of SNP members
5.    Manages new alerts and updates Case Manager of change in condition, admission, discharge, or new diagnosis
6.    Establishes relationships with members, earns their trust and acts as patient advocate
7.    Escalates concerns to nurse if members appear to be non-compliant or there appears to be a change in condition
8.    Assists with outreach activities to members in all levels of Case Management Programs.
9.    Assists with maintaining and updating member’s records
10.    Assists with mailing or faxing correspondence to members, PCP’s, and/or Specialists 
11.    Requests and uploads medical records from PCP’s, Specialists, Hospitals, etc., as needed
12.    Attends Interdisciplinary Team Meetings and participates in member presentations as appropriate.
13.    Meets specific deadlines (responds to various workloads by assigning task priorities according to department policies, standards and needs)
14.    Maintains confidentiality of information between and among health care professionals
15.    Other duties as assigned by CM Supervisor, Manager or Director of Care Management

Job Requirements:

Experience:

• Required: Minimum 1 year experience working in Health Care IPAs. Minimum 1 year experience  entering referrals and prior authorizations.

• Preferred:

Education:

• Required: High School Diploma or GED.  Bachelor's degree or four years additional experience in lieu of education.

• Preferred: MBA

Training:

• Required:

• Preferred: Medical Assistant training, Medical Terminology training.

Specialized Skills:

• Required:

• Ability to read and interpret documents such as safety rules, operating and maintenance instructions and procedure manuals.  Ability to write routine reports and correspondence.  Communicates effectively using good customer relations skills.
• Ability to communicate positively, professionally and effectively with others; provide leadership, teach and collaborate with others.
• Problem-Solving Skills:  Effective problem solving, organizational and time management skills and ability to work in a fast-paced environment.
• Knowledge of Managed Care Plans
• Knowledge of Medi-Cal
• Basic Computer Skills, 25 WPM (Microsoft Outlook, excel, word)
• Mathematical Skills:  Ability to add and subtract two digit numbers and to multiply and divide with 10’s and 100’s.  Ability to perform these operations using units of American money and weight measurement, volume, and distance.
• Reasoning Skills:  Ability to apply common sense understanding to carry out detailed but uninvolved written or oral instructions.  Ability to deal with problems involving a few concrete variables in standardized situations.
• Bilingual (English/Spanish),

Licensure:

• Required: None

• Preferred: Medical Assistant Certificate, Medical Terminology Certificate

Essential Physical Functions:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1.  While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.

2. The employee frequently lifts and/or moves up to 10 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.

Work Environment

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Pay range may be based on a number of factors including market location, education, responsibilities, experience, etc.

Alignment Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity, or sexual orientation.

*DISCLAIMER: Please beware of recruitment phishing scams affecting Alignment Health and other employers where individuals receive fraudulent employment-related offers in exchange for money or other sensitive personal information. Please be advised that Alignment Health and its subsidiaries will never ask you for a credit card, send you a check, or ask you for any type of payment as part of consideration for employment with our company. If you feel that you have been the victim of a scam such as this, please report the incident to the Federal Trade Commission at https://reportfraud.ftc.gov/#/. If you would like to verify the legitimacy of an email sent by or on behalf of Alignment Health’s talent acquisition team, please email [email protected].