Medi-Cal Eligibility Specialist
$67.1k - $76.96kHabitat Health
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
- 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
$67.1k - $76.96k
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