Medi-Cal Eligibility Specialist

Job Description

Job Description

Habitat Health empowers older adults to experience more good days in their homes and communities. Through the Program of All-Inclusive Care for the Elderly (PACE), we provide comprehensive medical care along with support for daily needs such as meals, transportation, and in‑home assistance. We deliver coordinated clinical and social care in our centers and directly in participants' homes, creating a fully integrated experience that brings peace of mind and a true sense of belonging. As we expand our scalable, affordable PACE model to meet the growing and complex needs of aging populations, our mission‑driven care teams continue to help participants live well on their own terms.

Habitat Health is supported by leading healthcare organizations and investors including New Enterprise Associates, Kaiser Permanente, and Town Hall Ventures. We are entering a period of significant growth and are looking for exceptional teammates to help us scale a better model of care for older adults. To learn more, visit

Role Scope :

This is an opportunity for a highly motivated and detailed oriented individual that is responsible for supporting prospective participants and existing participants navigate Medi-Cal eligibility and redeterminations. This individual will work closely with Habitat Health's Outreach & Enrollment to support prospective participants apply for Medi-Cal eligibility, follow-up on application status, and answer questions that prospective participants may have. This individual will also work with Habitat Health's Health Plan team to help existing participants navigate redeterminations. This role requires a combination of excellent customer service skills, attention to detail, deep understanding of Medi-Cal eligibility and redetermination, and proficiency in managing and processing multiple Medi-Cal eligibility and redetermination applications.

• Partner with center staff, health plan, and outreach & enrollment to triage Medi-Cal status issues that affect PACE eligibility

• Track Medi-Cal application pipeline to inform Growth and Health Plan operations

• Gather all necessary documentation to create, submit, pursue, and appeal Medi-Cal eligibility for prospective participants and existing participants for re-eligibility / redetermination with Medi-Cal

• Visit senior's homes as needed to gather necessary documentation to submit complete applications and redeterminations

• Maintain a strong working relationship with the County and Local social service agencies (e.g., DPSS) to ensure seamless enrollment and re-eligibility workflow, adhere to deadlines and ensure compliance with DHCS and CMS guidelines and policies

• Create and conduct Medi-Cal eligibility events at Habitat Health Centers, with community partners, and virtual sessions.

Qualifications:

• Minimum of three (3) years of experience working directly with the county DPSS submitting, managing, and appealing Medi-Cal eligibility and redeterminations

• Demonstrate in-depth knowledge of Medi-Cal rules, processes, practices, and options for Medi-Cal eligibility and redetermination

• Demonstrated knowledge and experience with complex Medi-Cal eligibility and redetermination case management

• Excellent verbal and written communication skills

• Willing to work weekends as necessary, particularly for community events

• Proof of medical clearance for communicable diseases, including a TB test

• Proof of all immunizations is up to date

• Proof of valid CA driver's license, personal transportation, good driving record and auto insurance as required by State law

Nice to have:

• Bilingual (Spanish/English) strongly preferred

• A minimum of one year experience working with the frail or elderly

• Experience working with the Medicare and Medicaid populations and within a healthcare organization

Compensation:

We take into account an individual's qualifications, skillset, and experience in determining final salary. This role is eligible for medical/dental/vision insurance, paid parental leave (birthing and non-birthing parents), short and long-term disability, life insurance, flexible spending accounts, 401(k) savings, paid time off, and company-paid holidays. The expected salary range for this position is $68,600 - $78,600. The actual offer will be at the company's sole discretion and determined by relevant business considerations, including the final candidate's qualifications, years of experience, skillset, and geographic location.

At-Will Employment

Employment with Habitat Health is at-will. This means that either the employee or the employer may terminate the employment relationship at any time, with or without cause, and with or without notice, subject to applicable law. Nothing in this job posting or any other company document is intended to create a contract of employment, express or implied, or to alter the at-will nature of employment.

Any written or oral statements to the contrary are not authorized unless made in writing and signed by an authorized representative of the Company.

Vaccination Policy, including COVID-19

To help maintain a safe environment for our participants and team members, Habitat Health maintains vaccination and infection control policies applicable to certain roles and work locations. For COVID-19 and influenza, team members who are working in a participant care setting are required to provide either proof of vaccination or a signed declination form and comply with applicable masking requirements while in a care setting to the extent permitted by law in the applicable jurisdiction.

Habitat Health will consider requests for reasonable accommodation based on an applicant's disability, medical condition, or sincerely held religious belief, practice, or observance in accordance with applicable law.

As a condition of employment, team members are expected to comply with all applicable infection control protocols, personal protective equipment (PPE) requirements, and vaccination requirements associated with their role and work location, and to the extent required by law and as permitted in the applicable jurisdiction.

Our Commitment to Equal Opportunity and Inclusion

Habitat Health is an Equal Opportunity Employer committed to the principles of equal opportunity and inclusion. Employment decisions at Habitat Health are based on qualifications, merit, and business needs. We do not discriminate on the basis of race, color, religion, creed, sex, gender (including pregnancy, childbirth, breastfeeding, and related medical conditions), gender identity, gender expression, sexual orientation, marital status, registered domestic partner status, age, national origin, ancestry, citizenship, military or veteran status, physical or mental disability, medical condition, genetic information, reproductive health decision-making, or any other characteristic protected by applicable federal, state, or local law.

Habitat Health is committed to the full inclusion of all qualified individuals. Consistent with applicable law, we provide reasonable accommodations to qualified individuals with disabilities and to individuals with religious beliefs, practices, or observances that require accommodation.

If you require a reasonable accommodation to participate in the application or interview process, perform the essential functions of a position, or receive other employment benefits and privileges, please contact us at View email address on ziprecruiter.com.

We encourage individuals from all backgrounds to apply, even if their experience does not align perfectly with every qualification listed.

E-Verify Participation Notice

Habitat Health participates in E-Verify and will provide the federal government with information from your Form I-9 to confirm your authorization to work in the United States.

If E-Verify cannot confirm your authorization to work, Habitat Health will provide you with written instructions and an opportunity to contact the Department of Homeland Security (DHS) and/or the Social Security Administration (SSA) to resolve the issue before any adverse employment action is taken, including termination of employment.

E-Verify is used only after an applicant has accepted an offer of employment and completed the Form I-9 and to the extent permitted by applicable law.

Habitat Health complies with all federal and state employment eligibility verification requirements.

Beware of Scams and Fraud

Habitat Health is committed to protecting job seekers from recruitment scams. Please ensure that you submit applications only through Habitat Health's official careers website or authorized job boards.

Official communications from Habitat Health recruiters and team members will come from email addresses ending in @habitathealth.com. Habitat Health will never ask applicants to pay fees, purchase equipment, or provide sensitive financial information as part of the recruiting or hiring process.

If you receive suspicious communications claiming to represent Habitat Health, we encourage you to exercise caution and independently verify the communication before responding.

If you believe you have been the victim of a recruitment scam or fraudulent job posting, please report the incident to the Federal Trade Commission (FTC) through its fraud reporting website at reportfraud.ftc.gov.