Enhanced Care Management Specialist Kindful Restoration - 1.0 Riverside, CA Job Details Full-time From $25 an hour 3 hours ago Benefits Health insurance Dental insurance Paid time off 403(b) Qualifications Customer communication Inpatient experience Utilization review Interpersonal skills Health insurance policy knowledge Coding for hospital billing HIPAA Transitional care planning in clinical case management Acute care facility experience Electronic health record (EHR) management for billing and coding Utilization management Resource utilization in healthcare Health information regulatory compliance Health record tracking Working with individuals from diverse cultural backgrounds Productivity software Managing patient records Medical terminology Cross-functional communication Full Job Description Job Overview We are seeking a dynamic and compassionate Enhanced Care Management Specialist to join our dedicated healthcare team. In this role, you will be at the forefront of coordinating comprehensive patient care, ensuring seamless communication across multidisciplinary teams, and facilitating optimal health outcomes for diverse populations. Your expertise will drive patient-centered solutions, discharge planning, and utilization management, all while navigating complex medical systems with confidence and clarity. This is an exciting opportunity to make a meaningful difference in the lives of individuals requiring specialized care coordination and support. Responsibilities Conduct thorough intake assessments to identify patient needs, including social services, behavioral health, and medical requirements. Develop individualized care plans that incorporate discharge planning, utilization review, and managed care strategies to promote optimal recovery and stability. Collaborate effectively with hospital staff, social workers, healthcare providers, and community resources to coordinate services across acute care, ICU, pediatric units, and trauma centers. Utilize EMR (Electronic Medical Record) systems and EHR (Electronic Health Record) systems to document patient interactions accurately and maintain comprehensive records in compliance with HIPAA regulations. Perform utilization management and review to ensure appropriate level of care, including working within Level I and Level II trauma centers when applicable. Communicate clearly with patients and their families across diverse cultural backgrounds to explain treatment plans, discharge instructions, and available social services. Maintain up-to-date knowledge of medical terminology, CPT coding, ICD-9/10 coding standards, and health insurance policies to facilitate accurate documentation and billing processes. Requirements Proven experience in critical care settings such as ICU, emergency medicine, hospital medicine or pediatrics. Strong background in hospital experience with familiarity in discharge planning, utilization review, and managed care processes. Nursing license or relevant healthcare certification preferred; experience with social work or behavioral health is highly valued. Knowledge of ICD coding (ICD-9/10), CPT coding, HIPAA regulations, and EMR/EHR systems is essential. Excellent client communication skills with the ability to work effectively with individuals from diverse cultural backgrounds. Experience working within Level I or Level II trauma centers or working in a Level III trauma environment is advantageous. Bilingual abilities are a plus to support diverse patient populations. Proficiency in Microsoft Office applications for documentation and reporting purposes. Strong understanding of health insurance policies, utilization management principles, and discharge planning procedures. Join us as an Enhanced Care Management Specialist if you're passionate about delivering exceptional patient service through coordinated care initiatives! Your expertise will help improve health outcomes while supporting patients through complex medical journeys with compassion and professionalism.

Pay:

From $25.00 per hour Expected hours: 40.0 per week

Benefits:

403(b) Dental insurance Health insurance Paid time off People with a criminal record are encouraged to apply

Work Location:

In person