Cook

Cook

Prior Authorization(On-Site)

$23-25 / hour

Job Description

Position Overview

The Prior Authorization Specialistis responsible for supporting Coast Cares contracting programs, including CalAIM, HCBS, SCRC, SDRC, and future payer partnerships. This position facilitates client access to services by coordinating referrals, assisting with caregiver onboarding, and ensuring accurate documentation in compliance with program and regulatory requirements. The Prior Authorization Specialist serves as a primary liaison with clients, caregivers, healthcare providers, and community partners, and is expected to operate effectively in a fast-paced, high-volume environment where responsibilities and priorities are subject to change on a daily basis.

Essential Duties and Responsibilities

Outreach and Relationship Management

Serve as the initial point of contact for community partners, healthcare providers, and clients regarding referrals and program inquiries.

Establish and maintain positive working relationships with referral sources and community organizations.

Represent Coast Care at community outreach events, orientations, and partner meetings, as assigned.

Referral and Intake Coordination

Process and track incoming referrals to ensure timeliness, accuracy, and completeness.

Verify client eligibility and collect required documentation in accordance with program standards.

Assist clients and caregivers throughout the onboarding process, ensuring a positive and supportive experience.

Operational and Administrative Support

Manage a high volume of calls, emails, and text messages daily while maintaining professional communication standards.

Adapt to frequent changes in workflow, priorities, and program requirements, ensuring all assigned tasks are completed accurately and on time.

Collaborate with internal departments, including scheduling, care management, recruitment, and operations, to ensure alignment with service delivery standards.

Maintain complete and accurate records, authorizations, and verification documents to support compliance and audit readiness.

Compliance and Reporting

Ensure strict adherence to program requirements, payer contracts, and regulatory guidelines.

Assist with preparation of documentation and reports for compliance reviews and audits.

Support departmental performance objectives, including referral conversion, onboarding timeliness, and service delivery metrics.

Qualifications

Required :

Associate degree in Healthcare Administration, Social Services, Public Health, or a related field; equivalent work experience may be considered.

Minimum of one (1) to two (2) years of experience in healthcare, social services, community outreach, or a related field.

Demonstrated ability to work effectively in a dynamic, high-volume environment with shifting daily priorities.

Strong organizational skills, attention to detail, and ability to manage multiple tasks simultaneously.

Proficiency with Google Workspace, and the ability to quickly learn new systems (e.g., AlayaCare, Viventium).

Excellent verbal and written communication skills with the ability to interact professionally with diverse populations.

Preferred :

Experience with Medi-Cal, CalAIM, HCBS, or other payer-based programs.

Bilingual proficiency in one of the following : Arabic , Spanish, Vietnamese, Tagalog, or another commonly spoken community language.

Knowledge of community-based resources and social service programs.

Performance Standards

Timeliness and accuracy in processing referrals and client onboarding.

Effective management of a high volume of communications while maintaining quality and professionalism.

Consistent adherence to program, payer, and regulatory requirements.

Positive feedback from clients, caregivers, and community partners.

Demonstrated contribution to departmental and organizational performance objectives.

Working Conditions

This position requires the ability to manage multiple responsibilities in a fast-paced environment with frequent interruptions. Coordinators must be adaptable to daily changes in workflow and priorities and comfortable handling a large volume of client and partner communications.

Organizational Relationships

Reports to : Contracting Program Manager

Collaborates with : Scheduling, Care Management, Recruitment, and Operations teams

Compensation details : 17-23 Hourly Wage

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