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Healthcare Coordinator

4 weeks ago

Orange, California, United States The Midtown Group Full time
Job Description

Our client is seeking a highly motivated and experienced Personal Care Coordinator Sr. to join their team. The Personal Care Coordinator Sr. will perform a wide variety of advanced support activities for plan members. The incumbent will ensure regular communication of the member's annual Health Needs Assessment (HNA) or Health Risk Assessment (HRA) and care plan with the member, primary care provider (PCP) and health care team.

The incumbent will regularly assess the quality of service given to the member's care by identifying barriers and assisting in improving these barriers for all levels of care. The incumbent will maintain strong working relationships with the PCP and health care team to ensure member access to timely services and coordination of care.

Key Responsibilities:

  • Participate in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.
  • Assist the team in carrying out department responsibilities and collaborate with others to support short- and long-term goals/priorities for the department.
  • Maintain strong working relationships when collaborating with the PCP and health care team to ensure timely communication of member's clinical information and ensures appropriate documentation of all interventions.
  • Collaborate with licensed professionals in development of a care plan for each member, incorporating the HNA or HRA all assessment findings.
  • Facilitate communication of care plan to the PCP and member, as necessary.
  • Develop and implement a member's specific care plan which includes prioritized Specific, Measurable, Achievable, Relevant, and Time-Bound (SMART) goals.
  • Facilitate and participate in interdisciplinary team meetings as applicable.
  • Process and maintain complex or sensitive documentation of member's case and care plan within the medical management system.
  • Facilitate referrals to Behavioral Health Services and identifies the need for referrals to Long-Term Support Services and community resources.
  • Facilitate transfers to member's assigned case manager in accordance with member needs, when appropriate.
  • Anticipate longer-term and more unique member needs by providing guidance in understanding and accessing the benefits they are entitled to under Medicare and Medi-Cal, as appropriate.
  • Maintain compliance with established departmental productivity guidelines; compile and conduct basic analyses and reporting of productivity metrics to management as required.
  • Coordinate and maintain cases in current case load in accordance with case management standards.
  • Assist with collection of health risk or health needs assessments as well as gathers medical records as needed.
  • Provide regular outreach to assigned members and evaluates quality of service given to members according to department contact standards.
  • Serve as the main point of contact for assigned members to anticipate longer term member needs.
  • Work with Case Management staff to expedite the resolution of member concerns.

Requirements:

  • High School diploma or equivalent required PLUS 2 years of experience working with the needs of members, such as but not limited to pediatric members, seniors or persons with disabilities (SPD) and/or special populations (e.g., homeless or at risk of homelessness) in a customer/member service capacity required.
  • Bachelor's degree in healthcare management, social work, human services or related field preferred.
  • 2 years of experience with health maintenance organization (HMO), Medical and health services preferred.
  • Experience working with individuals with behavior health conditions or substance use disorders preferred.
  • Bilingual in English and one of the defined threshold languages (Arabic, Chinese, Farsi, Korean, Spanish, Vietnamese) preferred.