Job Description
Position Description
+ Identify, triage, and transition continuity of care issues; assist members with the selection of Primary Care Providers (PCPs); explain program benefits; and facilitate referrals to internal programs, Community‑Based Organizations, and other appropriate services.
+ Assist members with authorizations and coordinate health care services among the Health Plan, network providers, Radiology Benefit Management (RBM), Specialty Pharmacy, Durable Medical Equipment (DME) vendors, and tertiary care facilities (e.g., UCLA and other Centers of Excellence) to ensure seamless continuity of care.
+ Resolve issues related to other health coverage, including researching and documenting coverage changes and notifying Recoveries and the Department of Social Services (DSS) as appropriate.
+ Provide guidance and support for the member portal, including education on portal features, navigation assistance, and general account inquiries.
+ Su...
+ Identify, triage, and transition continuity of care issues; assist members with the selection of Primary Care Providers (PCPs); explain program benefits; and facilitate referrals to internal programs, Community‑Based Organizations, and other appropriate services.
+ Assist members with authorizations and coordinate health care services among the Health Plan, network providers, Radiology Benefit Management (RBM), Specialty Pharmacy, Durable Medical Equipment (DME) vendors, and tertiary care facilities (e.g., UCLA and other Centers of Excellence) to ensure seamless continuity of care.
+ Resolve issues related to other health coverage, including researching and documenting coverage changes and notifying Recoveries and the Department of Social Services (DSS) as appropriate.
+ Provide guidance and support for the member portal, including education on portal features, navigation assistance, and general account inquiries.
+ Su...
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