Teams at Community Health Group

Provide Medicare member support and care coordination through home visits, phone outreach, scheduling, interpreter/transportation/prior authorization facilitation, documentation, grievance referral, and community resource linkage. Participate in on-call rotations and complete welcome calls.

Lead compliance activities and serve as the SIU investigator: investigate potential fraud, gather evidence, prepare reports, liaise with law enforcement and regulators, support privacy incident investigations, coordinate CMS/DMHC/DHCS audits, maintain compliance policies, deliver training, and track FWA program performance.

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.