Medi-Cal Specialist

At Habitat Health, we envision a world where older adults experience an independent and joyful aging journey in the comfort of their homes, enabled by access to comprehensive health care. Habitat Health provides personalized, coordinated clinical and social care as well as health plan coverage through the Program of All‑Inclusive Care for the Elderly (“PACE”) in collaboration with our leading healthcare partners, including Kaiser Permanente. Role Scope Support prospective participants and existing participants in navigating Medi‑Cal eligibility and redeterminations. Work closely with Habitat Health’s Outreach & Enrollment team to assist prospective participants in applying for Medi‑Cal eligibility, follow up on application status, and answer questions. Collaborate with the Health Plan team to help existing participants navigate redeterminations. Partner with center staff, health plan, and outreach & enrollment to triage Medi‑Cal status issues that affect PACE eligibility. Track the 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 for existing participants for re‑eligibility/redetermination. Visit seniors’ homes as needed to gather documentation and 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 in submitting, managing, and appealing Medi‑Cal eligibility and redeterminations. In‑depth knowledge of Medi‑Cal rules, processes, practices, and options for eligibility and redetermination. Experience with complex Medi‑Cal eligibility and redetermination case management. Excellent verbal and written communication skills. Willingness to work weekends as necessary, particularly for community events. Proof of medical clearance for communicable diseases, including a TB test. Proof of all immunizations up to date. Proof of a valid California driver’s license, personal transportation, good driving record, and auto insurance as required by state law. Nice to Have Bilingual (Spanish/English) strongly preferred. Minimum of one year of experience working with frail or elderly individuals. Experience working with Medicare and Medicaid populations within a healthcare organization. Compensation Salary range: $68,600 – $78,600. The company will consider qualifications, skill set, experience, and location. Benefits include 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. Vaccination Policy: Proof of COVID‑19 and flu vaccination (or a declination form) and required masking while in participant locations are essential requirements of this role. Requests for reasonable accommodations due to an applicant’s disability or sincerely held religious beliefs will be considered and may be granted based on review. Our Commitment to Diversity, Equity, and Inclusion Habitat Health is an Equal Opportunity employer and is committed to creating a diverse and inclusive workplace. Applicants are considered based solely on qualifications, without regard to race, color, religion, creed, sex, gender, gender identity, sexual orientation, marital status, military or veteran status, age, national origin, ancestry, citizenship, physical or mental disability, medical condition, genetic information, or characteristics of a family member. We will provide reasonable accommodations to applicants with disabilities or sincerely held religious beliefs in accordance with applicable law. #J-18808-Ljbffr Dormont Manufacturing Co