CalAIM Enrollment Specialist

CalAIM Enrollment Specialist

New Beginnings is seeking a qualified and experienced CalAIM Enrollment Specialist to provide comprehensive support for the Enhanced Care Management (ECM) and Community Supports (CS) programs under our CalAIM initiative. The CalAIM Enrollment Specialist will provide support in conjunction with the Authorization Specialist and Billing Specialist to ensure that all ECM and CS activities are effectively managed, including utilization management, member assignment, and reporting. This role requires a deep understanding of Medi-Cal and CalAIM processes, and the ability to optimize service delivery while ensuring compliance with all relevant regulations and standards.

Key Responsibilities:

  • Client Enrollment: Ensure all homeless services clients are enrolled in CenCal and CalAIM as eligible and appropriate. Process all enrollment paperwork.
  • Eligibility Tracking: Work with homeless services staff to ensure that all clients remain eligible for assistance as appropriate, and update and track their eligibility, ensuring no lapse in coverage,
  • Case Note and Service Quality Control: Review all staff case management notes for sufficient and appropriate service provision. Ensure case notes reflect accurate treatment and interventions and meet the standard for CalAIM service reimbursement.
  • Expiring Authorization Tracking: Work with CalAIM and case management staff to ensure the tracking of authorizations to ensure re-authorizations are submitted.
  • Process Optimization: Optimize internal and external CalAIM processes, making recommendations for improvements to enhance service delivery and program efficiency. Ensure processes are streamlined for Caseworkers while still aligning with CalAIM guidelines.
  • Documentation and Reporting: Review case notes for all claims made and related documentation in the Health Management Information System (HMIS). Assist in tracking authorizations and reauthorizations and assist with claims reviews as necessary to ensure accurate and timely billing.
  • Quality Improvement: Participate in internal and external meetings as necessary. Provide suggestions for quality improvement initiatives to enhance the effectiveness of ECM and Community Supports programs.
  • Additional Duties: Perform other duties as assigned by supervisors to support the successful implementation and operation of the CalAIM initiative.

Qualifications:

  • Education:
    • Bachelor’s degree in social work, psychology, counseling, nursing, public health, business or a related field.
  • Experience:
    • Minimum of 1-2 years of experience working with Medi-Cal/CenCal systems management.
    • Experience in reviewing care coordination tasks.
    • Proven track record in implementing CalAIM or similar healthcare programs preferred.
    • Familiarity with utilization management, provider oversight, and billing processes in a healthcare setting.
  • Skills and Competencies:
    • Strong Team Player with the ability to work cohesively in a team environment.
    • In-depth knowledge of Medi-Cal, CalAIM, the CalAIM Portal, and the needs of the Medi-Cal member population.
    • Excellent organizational and time-management skills.
    • Ability to analyze complex data, review documentation, and track program performance.
    • Strong communication skills, both written and verbal, with the ability to work collaboratively with a variety of stakeholders.
    • Proficiency in HMIS and other care management software preferred but not required.
    • Familiar with client intake and assessments
    • Ability to work unsupervised, in the field for part of shift with a commitment to issues related to ending homelessness through employment
    • Ability to set priorities, meet deadlines and follow through
    • Excellent written and oral communication skills
    • Strong organizational and time management skills.
    • High level of accuracy and attention to detail.
    • Ability to multitask and prioritize.
    • Excellent administrative skills.
    • Strong computer skills and knowledge of databases and relevant software programs.
    • Ability to maintain professional conduct, attitude and appearance at all times
    • Proficiency in PC computer systems and Microsoft Office, including the ability to perform word processing, data entry, and other tasks at a computer workstation
    • Adhere to laws regarding confidentiality and reporting requirements; maintain knowledge of current HIPAA certification standards
    • Willingness to travel: Driver’s License: A valid driver’s license and an operating insured, registered vehicle is required at the time of application. A valid California Class C Driver’s License is required at the time of appointment.

Work Environment:

This is a full-time, on-site position located at New Beginnings’ main office in Santa Barbara, with travel up to Mid and North County offices as needed. The CalAIM Lead Care Specialist will work closely with the Homeless Services Director, our CalAIM team, ECM and Community Supports providers, our data analyst, individual program Directors, and various internal departments to ensure the successful implementation of CalAIM initiatives.

Work hours are Monday – Friday, 9-6 although there may be occasional nighttime and weekend hours to attend community events or attend to emergent client and administrative needs. Starting salary is $30-$32 per hour DOE with medical and dental benefits provided, 403b contribution and matching, as well as generous paid time off. Position begins asap.

Application Process:

Interested candidates are encouraged to submit a resume, cover letter and a list of three professional references to hr@sbnbcc.org. If we feel you are a good match for the position, you will be contacted to schedule an interview.