Jobs at Community Health Group

Perform community outreach and education about Medicare and Medi-Cal managed care; enroll eligible individuals into plans; conduct presentations, provider surveys, and health fair participation; collaborate with internal teams and attend trainings to ensure compliance with federal and state regulations.

Supervise case management activities to resolve Medicare member concerns, coordinate care and services (including home visits), document interactions, meet phone benchmarks, refer grievances, assist with transfers and billing issues, and partner with community organizations to address members' medical and social needs.

Maintain and audit provider data and delegate oversight across Symplr and QNXT systems. Produce and update provider directories, generate daily audits, ensure regulatory compliance (DHCS, DMHC, CMS), coordinate across departments, and support reporting and process improvements.

Provide utilization and case management for members, review clinical documentation and medical necessity, coordinate care and transitions, collaborate with providers, refer complex cases, support quality improvement, and ensure regulatory compliance.

Provide customer-focused case management for Medicare members: conduct home visits, coordinate medical, behavioral and social services, resolve member concerns, document interactions, assist with transfers and urgent care coordination, and work with community resources to address non-medical needs. Participate in on-call rotation and complete welcome calls, ensuring compliance with Medicare and state regulations.

Provide oversight of care coordination for assigned caseloads, conduct home visits, monitor inpatient/outpatient services, document in CHGNet and QNXT, facilitate transitions of care, ensure treatment plan compliance, assist providers with chronic and disease-specific management, participate in quality improvement, and collaborate with internal and external health care teams.