Care Continuation Specialist

4 weeks ago


Los Angeles, California, United States MedPOINT Management Full time
Job Summary

MedPOINT Management seeks a skilled Care Continuation Specialist to assist members in continuing care with established physicians. The ideal candidate will work closely with health plans to identify contracted and non-contracted providers, ensuring seamless transitions for ongoing care.

Key Responsibilities:

  • Collaborate with health plan coordinators, members, and providers to complete cases
  • Work with the Eligibility Team to confirm and upload member eligibility to MPM's system
  • Partner with Medical Directors to process denials and assess COC request criteria
  • Manage data entry, including creating authorizations from start to end
  • Adjudicate and maintain referrals according to Medi-Cal and Medicare timeframes
  • Outreach providers to verify demographics
  • Work with the Provider Network Team to upload non-contracted providers
  • Maintain case history documentation and store case documents
  • Support UM teams as needed
  • Assist the Client Support Center with high-volume calls as needed
  • Regular attendance in UM meetings

Requirements:

  • High School graduate or GED equivalent
  • 1 year of experience in the medical field
  • Knowledge of medical terminology
  • Proficiency in Microsoft Office programs, especially Word and Excel
  • Proficiency in EZ CAP a plus
  • Proficient in English and Spanish

Skills and Abilities:

  • Ability to effectively collaborate with all teams across MPM
  • Strong customer service skills with good telephone rapport
  • Ability to multi-task while remaining adaptable and flexible in a fast-paced environment
  • Strong verbal and written communication skills


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