Temporary Community Supports Specialist

This position is a temporary role facilitated through one of our contracted agencies and is not a direct employment opportunity with IEHP. The contracted agency offers an assignment length of up to six months, during which the candidate will provide support for IEHP.

What you can expect! 

Find joy in serving others with IEHP! We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an authentic experience!

Under the direction of the Supervisor, Community Supports,  the Community Supports Specialist is responsible for reviewing and processing Community Support Services authorization requests and decisions based on evidence-based criteria. This position also ensures provider and member outreach is made in a timely manner while maintaining a high level of customer service. The Community  Supports Specialist works directly with Community Supports providers, community agencies, members/caregivers, and other entities supporting member care to ensure coordinated care and serve as a resource person for internal and external entities for Community Supports benefits.

This is Preferred Bilingual position.

Commitment to Quality: The IEHP Team is committed to incorporate IEHP’s Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation.

1. Review clinical documentation for pre-service or retrospective reviews based on clinical criteria for appropriateness of Community Support services and care for ECM and CCM members. Screen ECM and CCM members for appropriate Community Supports needs and document findings.
2. Conduct interviews with members and their families both telephonically and face-to-face to assess and review their healthcare status and needs.
3. Facilitate referrals to resources such as LTSS, Independent Living and Diversity Services, Behavioral Health, and community resources. Oversee and complete closed loop referral process.
4. Build and maintain a positive working relationship with Providers, including, but not limited to, communication via in-person, over the phone, and through digital means such as email and fax.
5. Engage in quality improvement initiatives and projects, such as identifying and addressing HEDIS gaps, and by identifying, developing, and testing new practices for improving member health outcomes.
6. Discuss denials with members as identified by Community Supports supervisor, as needed.
7. Work collaboratively with the Community Support team to ensure regulatory timeframes are upheld for authorization as per approved clinical criteria.
8. Collaborate with Community Supports Team to identify gaps in provider network. Report any provider issue as necessary for the Community Supports provider team to address.
9. Process timely and appropriate documentation in the medical management system.
10. Participate actively in LEAN activities to support the goals of the department
11. Attend staff meetings and education trainings necessary to maintain current standard work and Utilization Management knowledge.
12. Identify any grievance or quality issues from Community Supports providers and prepare documentation and reports as identified.
13. Conduct monthly Interdisciplinary Care Conferences as identified by the department.
14. Perform any other duties as required to ensure Health Plan operations and department business needs are successful.

Education & Requirements 

• Minimum of three (3) years of experience performing or facilitating social work or related services in a community-based setting
• Preferred experience in performing social work or related services in a Manage Care environment
• Bachelor’s degree required in social work or a related field from an accredited institution required
• This is a bilingual position. Identified bilingual team members in this role must take a language proficiency assessment and must receive a passing score

Key Qualifications

• Knowledge of community resources. Knowledge of Medicare and Medi-Cal benefits and eligibility criteria
• Skillful at offering information and education to members and their families
• Proven ability to:
  • Maintain a strong working relationship with all IEHP internal departments
  • Act as an advocate for members
  • Model commitment to continuous quality improvement
  • Model the highest ethical behavior in relationships with co-workers, supervisors, Members, Providers, and colleagues in the community
• This position may require up to 25% of travel when conducting field visits

Start your journey towards a thriving future with IEHP and apply TODAY!

This position is on a hybrid work schedule. (Mon & Fri - remote, Tues - Thurs onsite in Rancho Cucamonga, CA.)