Coordinator - Care Management

Date: May 12, 2022

Location: Rancho Cucamonga, CA, US

Company: Inland Empire Health Plans

Team Members are eligible to apply for a transfer or promotion after successfully completing their six-month introductory period AND have no open/active performance improvement plan (PIP). In addition, Team Members must meet the minimum requirements of the position for which they are applying. Member Services Representatives and Registered Nurses must complete one year of service in their current role as well as the requirements above.


Position Summary/Position


Under the general supervision of the Care Management (CM) Manager and direct supervision of the CM Coordinator Supervisor, the CM Coordinator is responsible for advocating, facilitating and supporting care management activities.


This is a Bilingual (English/Spanish) position. The team member in this role must take a language proficiency assessment and receive a minimum score of 9.

Major Functions (Duties and Responsibilities)

1. Responsible for assisting Members with care coordination in respect to referral process such IPA for Durable Medical Equipment (DME), home health, and Specialist needs.
2. Responsible for assisting with the referral process by contacting providers by phone, fax or email to request additional medical information as needed.
3. Responsible for assisting the Care Managers in the management and coordination of care of Member identified with care management conditions
4. Responsible for facilitating Member care to ensure that a continuity of care letter of agreement (LOA) is executed when appropriate.
5. Collaborates on Member’s care issues with other team members and consults with NCM or CM supervisor to ensure that appropriate treatment plan is followed, thoroughly and promptly.
6. Responsible for processing and coordinating divorces, disenrollment, transportations, and language interpretation as needed and applicable.
7. Responsible for completing first
8. Assists with contact calls for monthly  HRA  pull, i.e. Complex Case Management and assisting with coordinating the members overall care as needed.
9. Responsible for identifying HEDIS gaps and contacting the member to address these gaps.
10. Responsible for covering Cisco ACD Queue telephone lines
11. Phone queue.
12. Assists with the coordination of access issues with PCP offices, specialists, radiology services  and   ancillary services such as PT, OT, speech therapies.
13. Ensures documentations  is accurate and in compliance with regulatory requirements and accreditation standards.
14. Consults with assigned nurses for clinical assessment and decision prior to taking action that are clinical in nature.
15. Participates in Medical Services staff meetings or other activities as needed
16. Promotes a positive and collaborative working environment within the CM Team.

Major Functions (Duties and Responsibilities) Cont

Supervisory Responsibilities

Leading: Self

Experience Qualifications


Bilingual (English/Spanish) - written and verbal skills required.


Two (2) years customer service experience in medical clinics, hospitals, or IPAs.

Preferred Experience


Managed care setting experience preferred.

Education Qualifications


High school diploma or GED required.

Preferred Education


Associate's degree or Bachelor’s degree from an accredited institution preferred

Professional Certification


Medical Assistant Certification preferred.

Professional Licenses

Drivers License Required


Knowledge Requirement


Knowledge of Utilization Management including referral process, ICD-10 and CPT codes preferred. Knowledge of utilization management process and care coordination in HMO or managed care setting. Knowledge of Medi-Cal, and Medicare managed care. Understanding of and sensitivity to multi-cultural community.

Skills Requirement


Excellent written and verbal communication and interpersonal skills. Strong organizational skills, typing 45 words per minute, proficient in Windows applications. Experience in data entry.

Abilities Requirement


Team  culture a must. Telephone courtesy. High degree of patience.

Commitment to Team Culture


The IEHP Team environment requires a Team Member to participate in the IEHP Team Culture. A Team Member demonstrates support of the Culture by developing professional and effective working relationships that include elements of respect and cooperation with Team Members, Members and associates outside of our organization.

Working Conditions


Communication with IEHP Members, which includes intensive telephone use, basic computer knowledge and word processing/data entry skills including computer keyboard and screens, distribution of reports, filing and copying of records and/or correspondence.

Work Model Location

Physical Requirements


Starting Salary: $45,884.80  - $55,993.60  

Pay rate will commensurate with experience



Nearest Major Market: Riverside
Nearest Secondary Market: Los Angeles