Disclaimer: Please note that only CVs submitted in English will be considered.
Profiles not provided in English will not be taken into account.
Aviso: Tenga en cuenta que solo se considerarán las hojas de vida presentadas en inglés.
Los perfiles que no se envíen en inglés no serán tenidos en cuenta.
Job Overview: Our client is seeking a motivated, compassionate, and highly organized Bilingual Primary Care Case Manager fluent in Spanish and Englishto help improve patient outcomes, strengthen patient engagement, and reduce unnecessary emergency room visits and hospital utilization.
The Case Manager will be responsible for proactively reviewing patient medical records, identifying patients who need follow-up care, contacting patients, and coordinating timely appointments with primary care providers through in-person visits or telehealth services.
This position requires someone who understands common medical conditions, can recognize potential gaps in care, communicates effectively with patients, and takes ownership of ensuring patients receive appropriate follow-up services.
Schedule: Monday
- Friday, 8:00 AM
- 5:00 PM PST, with a 1-hour unpaid break; Full-time, 40 work hours per week

Responsibilities:
Patient Chart Review & Identification: Review patient charts, medical histories, diagnoses, medications, and previous visits in the Electronic Medical Record (EMR); identify high-risk patients with chronic medical conditions, frequent emergency room visits, hospitalizations, missed appointments, or gaps in care; prioritize patients based on care needs and determine required follow-up appointments.
Proactive Patient Outreach & Scheduling: Contact patients by telephone in both English and Spanish to check on health status, discuss care needs,



and schedule in-person or telehealth appointments; follow up with patients who have missed or canceled appointments; educate patients on primary and urgent care service availability as a first point of contact for non-emergency concerns.
Emergency Room & Hospital Utilization Reduction: Conduct outreach following emergency room visits or hospital discharges to coordinate timely follow-up care; monitor high-utilization patients, document outreach outcomes, and escalate urgent symptoms or clinical concerns immediately to licensed clinical staff.
Chronic Disease Management & Care Coordination: Support patients managing chronic conditions (e.g., diabetes, hypertension, asthma, heart disease); identify overdue labs, screenings, or specialist follow-ups; reinforce treatment plans and coordinate with medical assistants, providers, and referral departments to address barriers to care.
Patient Education & Engagement: Explain the importance of preventive care, routine medical visits, and chronic condition management in patient-friendly language; build positive relationships to improve patient trust, engagement, and retention.
Documentation, Tracking & Reporting: Accurately document patient outreach, chart reviews, appointment scheduling, and follow-up outcomes in the EMR; track outreach activity, maintain lists of high-utilization patients, and generate regular reports while ensuring strict HIPAA compliance.

Requirements:
Bilingual in English and Spanish (required)



with strong verbal communication skills in both languages.
Experience in a medical office, primary care clinic, care coordination, case management, or patient outreach role.
Strong understanding of medical terminology and common acute and chronic health conditions.
Ability to review and understand patient medical records, diagnoses, and treatment recommendations.
Practical experience working with Electronic Medical Records (EMR).
Excellent organizational, communication, and follow-up skills with comfort making a high volume of outbound patient calls.
Ability to prioritize patients based on identified care needs and established clinical protocols.
Strong attention to detail and ability to manage multiple patient cases simultaneously.
Ability to work independently while collaborating effectively with providers and clinical staff.
Commitment to patient-centered care and improving healthcare outcomes.
Preferred

Qualifications:
Medical Assistant certification or prior clinical experience.
Experience in primary care, population health, chronic disease management, or utilization management.
Familiarity with Medi-Cal, managed care plans, and healthcare services in California.
Experience with post-hospital discharge follow-up, preventive care outreach, or high-risk patient populations.
Knowledge of quality measures, preventive screenings, and gaps in care.
Experience using PrognoCIS or similar EMR systems.
Performance Expectations & Key Metrics: Patient Outreach: Number of patients contacted and successfully engaged.
Appointment Conversion: Percentage of contacted patients successfully scheduled for primary care or telehealth visits.
Completed Visits: Percentage of scheduled appointments completed.
ER Utiliza

📌 Bilingual Primary Care Case Manager (Xico)
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📍 Xico