CalAIM Referral Coordinator

CalAIM Referral Coordinator

Job Description

Reports to:

Director, CalAIMS Program Pay Grade:

N/ADepartment/

Location:

Remote / HybridFLSA Classification:

Non-Exempt

Job Summary 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.

Essential Duties and Responsibilities 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.

Core Competencies 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 time frames.

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…