CalAIM Referral Coordinator

CalAIM Referral Coordinator

Job Description

The CalAIM Referral Coordinator is responsible for overseeing the full lifecycle of referrals across all CalAIM programs. This role manages incoming referrals by coordinating closely with program staff, maintaining accurate referral trackers, and ensuring all required forms and documentation are submitted accurately and in a timely manner to optimize revenue. The Coordinator serves as a key liaison, communicating effectively with the CS Coordinator, the CalAIM Director, and external partners to facilitate seamless care transitions.

The CalAIM Referral Coordinator serves as the central hub for all incoming referrals across CalAIM programs, ensuring a seamless and efficient intake process. This role is responsible for the systematic tracking, management, and timely submission of all necessary forms and patient documentation, which is critical to optimizing program revenue and ensuring compliance. By fostering strong communication lines with the CS Coordinator, the CalAIM Director, and internal program staff, the Referral Coordinator acts as a pivotal connector, proactively managing the flow of information, troubleshooting referral bottlenecks, and facilitating high-quality care transitions for our members. 

Include the following and other duties as assigned:

• Receive, review, process, and track CalAIM referrals from health plans, providers, hospitals, and community partners.
• Perform triage and eligibility verification for CalAIM Enhanced Care Management (ECM) and Community Supports (Housing Trio, Recuperative Care, etc.) in accordance with DHCS policy.
• Coordinate "warm handoffs" between referral sources, members, and internal care teams to ensure smooth service transitions.
• Maintain and update referral tracking systems, ensuring data integrity and timely submission.
• Complete reports as needed, including the Referral Tracking File (RTF)
• Serve as the primary point of contact for external partners (e.g., Molina, IEHP representatives) regarding referral status and coordination.
• Ensure all referral documentation is HIPAA-compliant, accurate, and submitted within designated turnaround times.
• Maintain referral records and case documentation in electronic health record (EHR) and care management systems.
• Monitor referral status, follow up with service providers, and ensure timely completion of referrals.
• Participate in case conferences, team meetings, and quality improvement initiatives.
• Prepare reports and maintain tracking logs related to referral volumes, outcomes, and performance metrics.
• Support audits and documentation reviews as required.

To perform the job successfully, an individual should demonstrate the following competencies:

CalAIM Referral Coordination & Program Knowledge

Demonstrates knowledge of CalAIM referral processes and service pathways to support timely access to care and services.

• Understanding of CalAIM programs, including Enhanced Care Management (ECM) and Community Supports, and the ability to apply eligibility and referral requirements.
• Ability to review, process, track, and coordinate referrals accurately and within established timeframes.
• Knowledge of care coordination principles and the importance of facilitating effective communication between referral sources, members, and care teams.
• Strong organizational and administrative skills with the ability to manage high-volume referral workflows, prioritize tasks, and adapt to changing demands while meeting established deadlines.
• Familiarity with community resources, managed care plans, and healthcare system partners.

Communication & Interpersonal Skills

Demonstrates the ability to communicate effectively and build positive working relationships with members, providers, and community partners.

• Strong verbal and written communication skills with the ability to exchange information clearly, accurately, and professionally.
• Demonstrated interpersonal skills, including active listening, relationship building, and customer service, to effectively collaborate with members, providers, health plans, and community partners.
• Ability to collaborate effectively with internal teams and external stakeholders to support service coordination.
• Strong organizational skills with the ability to prioritize tasks and follow up on outstanding items.
• Ability to maintain professionalism, discretion, and composure in a fast-paced environment.

Documentation, Compliance & Technology

Demonstrates the ability to maintain accurate records, protect confidential information, and utilize technology to support referral operations.

• Ability to complete and maintain accurate, timely, and organized documentation and referral records.
• Knowledge of HIPAA, confidentiality requirements, and professional standards for handling protected health information.
• Strong computer skills, including proficiency with electronic health records (EHR), referral tracking systems, data entry, care management platforms, Google Workspace, and other relevant technologies.
• Ability to enter, review, and maintain accurate data while exercising sound judgment and attention to detail.
• Ability to support audits, reporting activities, and quality improvement efforts by ensuring documentation completeness and data accuracy.

Cultural Responsiveness & Professionalism

Demonstrates the ability to work effectively with diverse populations while promoting dignity, respect, and professional conduct.

• Demonstrated cultural humility and ability to work effectively with individuals from diverse backgrounds and lived experiences.
• Demonstrated ability to work with underserved populations with compassion, respect, and without discrimination or judgment.
• Ability to interact with members, families, providers, and community partners using empathy, professionalism, cultural humility, and a participant-centered approach.
• Commitment to participant-centered service delivery, confidentiality, and ethical conduct.
• Promotes a collaborative and inclusive environment that supports positive member experiences and outcomes.

In addition to job-specific competencies, all Symba Center employees are expected to demonstrate the following core competencies to align with the Company’s culture and core values. 

Mission & Values Alignment
Demonstrates commitment to Symba Center’s mission, values, and community outcomes in day-to-day decisions. Behavioral indicators:

• Connects personal work outputs to organizational impact.
• Prioritizes community benefit over convenience or ego.
• Uses Symba’s values in tradeoff decisions (e.g., speed vs. quality vs. equity).

Equity, Inclusion & Cultural Humility

Acts to reduce bias, increase access, and respect diverse lived experiences; seeks to understand rather than assume. Behavioral indicators:

• Uses inclusive language and practices; adapts communication styles.
• Anticipates barriers for underserved stakeholders and designs equitable solutions.
• Reflects on personal biases and invites feedback; elevates underrepresented voices.

Ethics, Safeguarding, & Compliance

Upholds legal/organizational standards, protects vulnerable populations, and reports concerns promptly. Behavioral indicators:

• Protects confidentiality.
• Follows mandatory reporting and risk protocols without delay.
• Flags conflicts of interest; chooses ethical paths even when inconvenient.

Communication & Collaboration

Shares information clearly and timely; builds trust and outcomes through teamwork. Behavioral indicators:

• Tailors messages to audience (community, funders, coworkers).
• Practices active listening; clarifies assumptions and decisions.
• Escalates issues constructively; closes the loop on commitments.

Service Mindset & Relational Stewardship

Anticipates stakeholder needs; nurtures relationships that advance impact. Behavioral indicators:

• Sets and meets expectations; follows through reliably.
• Treats every stakeholder with dignity; handles complaints gracefully.
• Balances responsiveness with boundaries and sustainability.

Operational Excellence & Accountability

Manages time, resources, and processes with integrity and discipline. Behavioral indicators:

• Meets deadlines; communicates risks early.
• Follows standard operating procedures (SOPs); improves them over time.
• Owns outcomes; corrects mistakes quickly.

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this position. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this position.

This position is primarily performed in a remote and office-based environment and requires extended periods of sitting, working at a computer, and participating in virtual meetings. The employee must be able to communicate effectively with staff, clients, managed care plans, community partners, and other stakeholders through video conferencing, telephone, email, and in-person interactions.

The employee must possess sufficient visual acuity to review electronic records, reports, and other documentation and manual dexterity to operate a computer, telephone, and other standard office equipment. The ability to manage multiple tasks simultaneously, maintain attention to detail, and meet deadlines in a fast-paced environment is required.

This position requires regular travel between program sites, partner agencies, and community locations within the service area. Travel may include attending meetings, conducting site visits, providing staff support, performing program audits, and monitoring program operations. The employee must be able to transport materials and equipment weighing up to 15 pounds on an occasional basis.

The work environment includes remote, office, healthcare, community-based, and social service settings. The employee must be able to adapt to varying work environments and maintain professionalism, sound judgment, and effective working relationships with diverse populations and stakeholders.

This position requires the following education and experience:

High school diploma is required. A minimum of one (1) year of experience in healthcare administration, social services, or case management, ideally within the Medi-Cal/CalAIM landscape, or related programs is required. Prior knowledge of CalAIM populations of focus an Community Supports service standards is highly preferred. 

The Company, at its sole discretion and on a non-precedent setting basis, may determine that a candidate/employee with less than the required year(s) of experience/education is qualified and eligible for placement in this role because of education and/or demonstrated competencies and proficiency.

This position requires the following certifications, licenses, and/or registrations:

• Valid California Class C Driver’s License is required. 
• Current Basic Life Support (BLS) for Healthcare Providers certification is required. 

Ability to work flexible hours, as required, including weekends and holidays.