Temp Medical Management Personal Care Coordinator

TEMPORARY POSITION

FLSA Status: Non-Exempt
Department: Health Services
Reports To: Health Services Management

GENERAL DESCRIPTION OF POSITION

The Medical Management Personal Care Coordinator is responsible for supporting and coordinating internal and external resources for members referred to case management programs for all lines of business in compliance with all applicable state and federal regulatory requirements, SCFHP policies and procedures, and business requirements.

ESSENTIAL DUTIES AND RESPONSIBILITIES

To perform this job successfully, an individual must be able to satisfactorily perform each essential duty listed below.

1. Work with case managers to assist members navigating the healthcare delivery system and home and community-based service to facilitate access related to medical, psychosocial and behavioral health benefits and services.
2. Monitor and respond to inbound case management inquiries and referrals and escalate to clinical staff, as appropriate. 
3. Provide outreach to members to facilitate timely completion of Health Risk Assessments (HRA’s) by telephone, mail or in person, as needed. 
4. Support the coordination of member care with PCP, Specialists, Behavioral Health and Long Term Services and Supports providers and other stakeholders to assist member to achieve or maintain a level of functional independence which allows them to remain at home or in the community.
5. 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).  Oversee correspondence related to care plans. Document ICT meetings following SCFHP policies and procedures.
6.  Support successful transition of care for members who move between care settings by coordinating services for medical appointments, pharmacy assistance and by facilitating utilization review.
7. Follow UM policies and procedures for new authorization requests.  May conduct data entry into the authorization software application system and determination notification to member and/or provider in accordance with regulatory timeframes.
8. Produce and distribute internal reports that may include QI reports and member admission and discharge reports, as appropriate.
9. Follow established Medical Management policies and procedures and use available resources to respond to member and/or provider inquiries and resolve any concerns in an accurate, timely, respectful, professional and culturally competent manner. 
10. Maintain knowledge of current resources in communities served by our members to support case management goals.
11. Develop effective and professional working relationships with internal and external stakeholders and partners.  Communicate effectively with members and providers orally and in writing.
12. May support and conduct non-clinical training in accordance with training guidelines and protocols; provide input and develop training and reference materials for internal systems.  
13. Identify issues and trends (data, systems, member, provider, other) as well as general departmental questions/concerns; report relevant information to management; and make recommendations to improve operations.
14. Collaborate with team members on improvement efforts across-departments regarding quality improvement projects, optimization of utilization management, and member satisfaction. 
15. Attend and actively participate in daily, weekly, and monthly departmental meetings, in-services, training and coaching sessions.
16. Perform other duties as required or assigned.

REQUIREMENTS – Required (R)   Desired (D)

The requirements listed below are representative of the knowledge, skill, and/or ability required or desired.

1. Bachelor's Degree in a health related field or equivalent experience, training or coursework.  (R)
2. Minimum three years of relevant experience in a healthcare or community setting providing care coordination of health and/or social services. (R)  
3. Maintenance of a valid California driver’s license and acceptable driving record, in order to drive to and from offsite meetings or events; or ability to use other means of transportation to attend offsite meetings or events. (R)
4. Knowledge of Medicare and/or Medi-Cal benefits, community resources and principals of case management. (D)
5. Spanish, Vietnamese, Chinese, or Tagalog language bi-lingual skills. (D) 
6. Knowledge of medical terminology. (D)
7. Knowledge of Santa Clara County Health and Social Services. (D)
8. Proficient in adapting to changing situations and efficiently alternating focus between telephone and non-telephone tasks to support department operations as dictated by business needs. (R)