Center for Elders' Independence Careers

Description

BENEFITS CASE MANAGER

The Center for Elders’ Independence (CEI) provides a Program of All-Inclusive Care for the Elderly (P.A.C.E.) - a comprehensive healthcare model specifically designed for low-income, frail seniors. It combines medical and social services along with vigilant care planning and coordination in order to keep frail seniors safely living at home and in their communities. This unique and highly effective model utilizes an interdisciplinary team approach to care planning to drive high quality, affordable, integrated healthcare services to the elderly.

Position Description

Under the supervision of Director of Enrollment and Member Services, the Benefits Case Manager ensures that all CEI participants are enrolled in all income and insurance benefits that they are eligible for.  Benefits Case Manager will be required to work effectively with participants, participant families, representative payees and relevant government agencies to proactively maintain and address benefit eligibility issues that arise as well as support different prospect/participant benefit related projects within the agency. 

Essential Job Functions:

Department and Caseload Management

• Benefits Case Manager keeps track and ensures that all participants’ benefits eligibility needs are met; this includes working directly with the participants, participant families, representative payees and the relevant government agencies to proactively maintain benefit eligibility and resolve all eligibility issues that arise.
• Manages the assigned participant eligibility caseload which includes attending enrollment, care conference meetings and conducting home visits with participants where eligibility issues need to be addressed.
• Manages the caseload information on participants in a well-organized and secure filing system as devised by the department.
• Keeps track and monitors the eligibility status of the participant assigned to the caseload and generates regular reports as needed.

Income Benefits

• Ensures that the CEI participants’ income information assigned to the caseload is known and verified at all times and is well documented in the CEI database.
• Ensures that accurate share-of-cost information is gathered, well documented and communicated with the participant on the caseload and the finance staff in an effective and in a timely fashion to enable CEI to collect share-of-cost revenue.

• Works with the participants, families and social workers connected to the assigned caseload to ensure that the Board and Care and SNF income level changes are made by the social security administration, that all involved understand the changes and that the benefit levels are accurate on all Board and Care documents.  

• Communicates income issues to social work, finance, member services and other pertinent staff as needed affiliated with the participant on the caseload to ensure interdepartmental effectiveness.

Insurance Benefits

• Ensures that all CEI participants’ benefit information on the assigned caseload is known and verified at all times and well documented in the CEI database.
• Ensures that CEI participants who are assigned to the caseload are fully enrolled in Medi-Cal and any Medicare benefits they are eligible for prior to enrollment and following enrollment (ie assist with getting participants who are Medi-Cal only qualify for Medicare and participant missing Medicare Part A qualified for QMB benefit to obtain Part A coverage).
• Manages Medi-Cal re-certification to ensure that eligibility is maintained for all participants and facilitate proper communication and documents if retro payment request needs to be processed for month reflecting no payment code. 
• Verify IHSS enrollment information prior to enrollment and document in CEI database for proper termination after enrollment.
• Communicates insurance issues to social worker, finance, member services and other pertinent staff as needed affiliated with the participant on the caseload to sure interdepartmental effectiveness.

Relevant Skills and Experience:

• High School diploma required.
• Experience or knowledge in benefit such as Medi-Cal, Medicare and other common benefits available for seniors.
• Excellent customer service and service recovery skills.
• Strong case management skills. Ability to work closely with cross-functional team members including Outreach and Enrollment staff and IDT staff at the PACE centers. 
• A demonstrated history of success in goal attainment.
• Excellent communication and presentation skills, both oral and written.
• Must be proficient with computer applications including spreadsheets, word processing and Customer Relationship Management (Salesforce).
• Excellent decision-making ability, customer service and negotiation.
• Possess the capacity to work in a high-stressed, high paced environment while maintaining a positive attitude.
• Self-motivated and able to work independently with minimal supervision.
• Bilingual preferred: English/Spanish; English / Cantonese or Mandarin Chinese; English / Vietnamese or other.
• A passion for working with the senior and underserved populations.

Physical and Travel Requirements:

• Ability to sit, stand, stoop, reach, lift (up to 40 pounds), bend, etc.; hand and wrist dexterity to utilize keyboard.
• Travel within assigned territory and agency sites and programs.
• Valid driver's license, reliable transportation and insurance coverage required.

Compensation and Perks:

• Benefits package: healthcare, dental, vision, life insurance, Flexible Spending Account, Health Savings Account, and additional voluntarily selected benefits.
• 403b matching.
• PTO (Paid-time-off) and paid holidays.
• Company laptop and cell phone provided.
• Pre-tax commuter benefits such as parking and transit.
• Mileage reimbursement.

The above job description is intended to communicate the general function of the mentioned position and by no means shall be considered an exhaustive or complete outline of the specific tasks and functions that will be required.  CEI reserves the right to change job descriptions, site assignments, and or work hours as required by the needs of the program.  All employees are expected to perform their duties within their ability as required by the job and/or as requested by management. 

Center for Elders’ Independence is a PACE (Program of All- Inclusive Care for the Elderly) organization that uses an interdisciplinary team approach to care planning and care implementation for the purpose of providing high quality, affordable, integrated health care services to the elderly, including an Adult Day Health Center, and promoting autonomy, quality of life and the ability of individuals to live in their communities. Unlike other healthcare plans, CEI is not a "fee-for-service" plan. It is a “capitation” healthcare plan. CEI is paid a set amount for each person enrolled in our program, whether or not that individual seeks care. We are a growing company that offers stability and continues to thrive.