Behavioral Health Care Coordinator

3 weeks ago


San Jose, California, United States Santa Clara Family Health Plan Full time
Behavioral Health Care Coordinator

Job Summary: We are seeking a highly skilled Behavioral Health Care Coordinator to join our team at Santa Clara Family Health Plan. The successful candidate will be responsible for supporting and coordinating internal and external resources for members referred to case management programs.

Key Responsibilities:

  • Work with case managers to assist members navigating the healthcare delivery system and home and community-based services.
  • Monitor and respond to inbound case management inquiries and referrals, escalating to clinical staff as necessary.
  • Provide outreach to members to facilitate timely completion of Health Risk Assessments (HRAs).
  • Support the coordination of member care with PCPs, specialists, behavioral health, and long-term services and supports providers.
  • Assist with coordinating the involvement of the interdisciplinary care team (ICT) members, including the member and/or their family/responsible party, to implement the individualized care plan (ICP).
  • Support successful transition of care for members who move between care settings by coordinating services for medical appointments, pharmacy assistance, and facilitating utilization review.
  • Follow UM policies and procedures for new authorization requests, conducting data entry into the authorization software application system and determination notification to members and/or providers.
  • Produce and distribute internal reports, including QI reports, member admission and discharge reports, and external stakeholder reports.

Requirements:

  • Bachelor's degree in a health-related field or equivalent experience, training, or coursework.
  • Minimum three years of relevant experience in a healthcare or community setting providing care coordination of health and/or social services.
  • Maintenance of a valid California driver's license and acceptable driving record, or ability to use other means of transportation to attend offsite meetings or events.
  • Knowledge of Medicare and/or Medi-Cal benefits, community resources, and principles of case management.
  • Knowledge of medical terminology.
  • Knowledge of Santa Clara County Health and Social Services.

Working Conditions: The incumbent will primarily work in an office environment, with frequent contact with and interruptions by coworkers, supervisors, and plan members or providers.

Physical Requirements: The incumbent must be able to perform the essential functions of this job, with or without reasonable accommodation, including mobility, lifting, visual, dexterity, hearing/talking, and reasoning requirements.



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