General Description This role is responsible for providing coordination of transportation benefits and takes the lead in coordinating all Non-Emergency Medical Transportation (NEMT) requests in support of member-facing department operations acting in accordance with Medi-Cal and Medicare guidelines. This role will function as an organizational subject matter expert on NEMT transportation benefits alongside the Transportation Program Manager. Qualifications The following represents the typical way to achieve the necessary skills, knowledge and ability to qualify for this position: Education and Experience
- High school diploma or GED required; college level courses in health care, a plus.
- One year of managed care experience preferably in Care Coordination.
- Experience working with the health needs of the population served.
- Experience as a Medical Assistant or Licensed Vocational Nurse is a plus. Skills
- Intermediate proficiency in Microsoft Office Suite applications.
- Bilingual fluency in Spanish, Tagalog, or Chinese preferred. Knowledge
- Working knowledge of care coordination, Medi-Cal, and Medicare benefits.
- Basic knowledge of complexities of working with the elderly and disabled population.
- Basic knowledge of the San Mateo County community resources such as food, caregiving, and housing resources preferred. Abilities
- Demonstrated ability to work cooperatively with others.
- Demonstrated ability to work as part of a team and support team decisions.
- Demonstrated ability to communicate effectively, both verbally and in writing.
- Ability to adapt to changes in requirements/priorities for daily and specialized tasks. Licensure/Certifications
- Not Applicable. Driving
- Not Applicable. DUTIES & RESPONSIBILITIES Essential Functions NEMT Program Operations
- Receive and process daily NEMT coordination requests, ensuring medical necessity and compliance in collaboration with Integrated Care Management and other customer support/member-facing teams.
- Act as a lead for NEMT inquiries, responding to members and providers to resolve concerns professionally and in a culturally competent manner.
- Consult with Care Management or Customer Support staff regarding transportation coordination as needed.
- Communicate with NEMT vendors and PCPs to coordinate PCS forms and prior authorizations while ensuring appropriate transportation modes for members.
- Collaborate with member-facing teams to resolve issues such as driver complaints, late pick-ups, and provider availability. NEMT Administrative Support
- Maintain and update transportation materials, including job aids, workflows, and program resources in collaboration with the Transportation Program Manager.
- Oversee ICM SDP transportation tickets, managing fax folders, emails, and phone requests.
- Assist members with scheduling appointments, educational classes, and transportation.
- Work with healthcare providers to coordinate and share treatment plans. Data and Reporting
- Perform data entry and maintain member information in the ICM case management system.
- Develop tracking reports related to census, program service monitoring, and utilization, and take meeting minutes as needed.
- Track and manage restricted ride lists and alternative transportation options for members who misuse benefits.
- Support Provider Services to ensure network and transportation provider lists are adequate and up to date.
- Assist in identifying new providers to enhance access and availability for members. Secondary Functions
- Support onboarding new ICM staff and help with regulatory audit preparation and review.
- Perform other duties as assigned.
