Care Coordinator

6 days ago

Orange, United States Alta Hospitals Full time

The Personal Care Coordinator (PCC) will serve as a liaison between OneCare members, the Prospect Medical Group, CalOptima, medical providers, behavioral health providers and Long Term Support Service (LTSS) providers. The PCC will identify and reduce barriers to members care, assist the member in locating and accessing resources and educate the member on the importance of accessing care promptly. The PCC will serve as the primary point of contact for the member and will be an integral part of the members interdisciplinary care team. The PCC provides support to the member as they self-navigate the health care system and works closely with members case management team to resolve access, medical and psychosocial related issues. The PCC must be able to efficiently manage and prioritize a caseload of 400-500 members while working under the direct supervision of a licensed clinical professional to ensure optimal coordination of care for the OneCare members.

With approximately 9,000 physicians to serve our 260,000 members, Prospect Medical Systems is proud to be among the most innovative medical systems in California, Texas and Rhode Island. Our extensive care services range from primary care and specialty physician services to acute care hospital and skilled nursing facilities to behavioral health and wellness services. Each of our Independent Physician Associations (IPAs) and networks support the use of advanced diagnostic and treatment tools to provide our members with convenient access to state-of-the-art healthcare. For 25+ years, Prospect Medical has been focused on our mission of supporting independent physicians where, through risk arrangements, we work closely together with health plans, facilities and healthcare physicians for the benefit of every person who comes to us for care. We provide quality healthcare services that are designed to offer our patients highly coordinated, personalized care and that help them live healthier lives. Prospect Medical Systems manages highly successful IPAs by leveraging our best-practices, results-driven administrative services to manage patients under risk arrangements with health plans/CMS.Collaborate with CalOptima PCC to ensure timely communication of member's clinical information.|Guide members in understanding and accessing the benefits they are entitled to under Medicare and Medi-Cal, through the OneCare program.
Assist with coordination of member's health care and social service needs both within and outside the Medical Group and CalOptima.|Facilitate communication of initial care plan to the primary care physician (PCP), PMG CalOptima and member, as indicated.|Assist the member with the following; preventive care goals and scheduling of appointments, facilitate referrals to LTSS, behavioral health and community resources. Initiate referrals to both internal and external care management departments and other department government or community agencies and facilitate warm transfers to member's assigned case manager in accordance with member needs, when appropriate.|Outreach to members to complete assessment when there are changes to a member's health status.|Prompt communication member's case notes, HRA, care plan and interdisciplinary care team (ICT) proceedings to CalOptima's PCC for integration in CalOptima's medical management system.Two (2) plus years experience working with the needs of seniors or persons with disabilities (SPD) in a customer/member service capacity.Associates degree

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