Esmeralda Moreno

Submissions for determination of medi-cal eligibility upon receipt of community pathway referrals and member renewal checks. Determination of appropriate providers,services and resources. Referral support for medically necessary services. Coordination of care and services in the community. Appropriate and timely linkage of services. Compliance with DHCS and all MCP requirements. Quality assurance and maintenance of relationships with contract holders and members/families served. Weekly attendance of meetings individually with supervisor and team with trainings/discussions focusing on: Whole person approach,discussion and focus on needs of individual members and families,focus on needs of staff, team and program development. Clinical review meetings of cases discussing risk assessments and member care plans. Coordination of quarterly multidisciplinary coordination of care meetings. Continuation of ongoing required training and certifications: Trvuti, Relias, COR and First Aid.

• Connected families with necessary social services, alleviating barriers to healthcare access and improving quality of life.
• Addressed patient concerns and provided support to vulnerable demographics.
• Promoted access to healthcare services for underprivileged populations through community outreach efforts.
• Helped vulnerable individuals navigate complex healthcare system.
• Supported families in navigating healthcare systems, improving their ability to obtain necessary medical care and social services.