Medi-Cal Eligibility & Redetermination 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. Habitat Health offers a fully integrated experience that brings more good days and a sense of belonging to participants and their caregivers. We build engaged, fulfilled care teams to deliver personalized care in our centers and in the home. And we support our partners with scalable solutions to meet the health care needs and costs of aging populations. Habitat Health is growing, and we’re looking for new team members who wish to join our mission of redefining aging in place. To learn more, visit Role Scope This is an opportunity for a highly motivated and detail‑oriented individual who is responsible for supporting prospective and existing participants navigate Medi‑Cal eligibility and redeterminations. The role requires collaboration with Habitat Health’s Outreach & Enrollment team, health plan team, and community partners to apply for Medi‑Cal, follow‐up on application status, and answer questions. Strong customer service skills, attention to detail, deep understanding of Medi‑Cal rules, and proficiency in managing multiple applications are essential. 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 seniors’ homes as needed to gather 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. Demonstrated 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. 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 up to date. Proof of a 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. 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. Vaccination Policy, including COVID‑19 At Habitat Health, we aim to provide safe and high‑quality care to our participants. We require either proof of vaccination or a declination form and required masking while in participant locations as a safe and essential requirement 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 upon review. Team members must adhere to all infection control, PPE standards and vaccination requirements related to specific roles and locations as a condition of employment. Our Commitment to Diversity, Equity, and Inclusion Habitat Health is an Equal Opportunity Employer and is committed to creating a diverse and inclusive workplace. Habitat Health applicants are considered solely based on their qualifications, without regard to race, color, religion, creed, sex, gender (including pregnancy, childbirth, breastfeeding or related medical conditions), gender identity, gender expression, sexual orientation, marital status, military or veteran status, age, national origin, ancestry, citizenship, physical or mental disability, medical condition, genetic information or characteristics (or those of a family member), or other status protected by applicable law. Habitat Health will take steps to provide people with disabilities and sincerely held religious beliefs with reasonable accommodations in accordance with applicable law. If you require a reasonable accommodation to fully participate in the job application or interview process, to perform the essential functions of the position, and/or to receive all other benefits and privileges of employment, please contact us at View email address on click.appcast.io. #J-18808-Ljbffr Habitat Health