Care Coordination Specialist

4 days ago


Burbank, California, United States Whole Care Solutions Full time
About Us

Whole Care Solutions is a leading case management organization founded by Registered Nurses committed to providing quality services to members enrolled in the Enhanced Care Management (ECM) Program through DHCS/CalAIM. We value hard work, celebrate successes, and believe in creating a workplace where everyone can thrive.

Job Description:
The Lead Care Manager will engage with ECM members to assess their needs, coordinate care, connect them to community resources, provide personalized support, helping them build resilience and self-management skills. Under the guidance of the Enhanced Care Management Director, the Lead Care Manager will work directly with members to develop individualized Care Plans, coordinate services, and connect them with resources to support a healthy, well-managed lifestyle.

Key Responsibilities:
  • Member Engagement: Engage members at the office or in community settings to offer and facilitate ECM services.
  • Comprehensive Assessments & Care Plans: Conduct thorough assessments to create individualized Care Plans, identifying goals that align with the members' unique physical, mental, and social health needs.
  • Care Plan Management: Ensure effective implementation of Care Plans.
  • Health Education & Self-Management: Educate members on self-management skills and engage caregivers or family members to support Care Plan goals as appropriate.
  • Support Behavioral Change: Utilize motivational interviewing and trauma-informed care practices to help members make positive health behavior changes.
  • Treatment Adherence Monitoring: Monitor members' adherence to Care Plans and collaborate with healthcare providers to address barriers to care.
  • Interdisciplinary Collaboration: Participate in case conferences with clinical providers, hospital staff, and community partners to align on member care needs and goals.
  • Social Support Coordination: Connect members to social services such as housing, transportation, and nutrition assistance to support Care Plan goals.
  • Transition of Care Support: Work with hospital staff to support seamless discharge planning and continuity of care post-discharge.
  • Member Accompaniment: Accompany members to office visits as needed, following health plan guidelines, and offer support during healthcare encounters.
  • In-Person & Scheduled Contact: Maintain regular contact with members, including in-person visits to reinforce support.
  • Documentation & Compliance: Document all care management encounters accurately in the Electronic Health Record (EHR) system with appropriate codes for billing and tracking.
  • Additional Duties: Perform other related duties as assigned, supporting the ECM program's objectives.

Salary: $85,000 - $115,000 per year

Requirements:
  • Education: High School Diploma required; Bachelor's degree preferred.
  • Experience: Community health/Healthcare or social service experience preferred.
  • Skills: Proficient in Microsoft Office Suite; experience with Electronic Health Records (EHR) is a plus.
  • Licensing: Valid driver's license and willingness for occasional travel within the community.
  • Language: Fluency in English and Spanish is required.
  • Interpersonal Skills: Strong communication and interpersonal skills; ability to work effectively in an interdisciplinary team and independently seek resources.


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