Care Management Coordinator I

The pay range above represents the minimum and maximum rate for this position in California. Factors that may be used to determine where newly hired employees will be placed in the pay range include the employee specific skills and qualifications, relevant years of experience and comparison to other employees already in this role. Most often, a newly hired employee will be placed below the midpoint of the range. Salary range will vary for remote positions outside of California and future increases will be based on the pay band for the city and state you reside in.

Work Culture:

GCHP strives to create an inclusive, highly collaborative work culture where our people are empowered to grow and thrive.  This philosophy enables us to create the health plan of the future and do our best work – Together.

GCHP promotes a flexible work environment. Employees may work from a home location or in the GCHP office for all or part of their regular workweek (see disclaimer).

GCHP’s focuses on 5 Core Values in the workplace:

•    Integrity

•    Accountability

•    Collaboration

•    Trust 

•    Respect

Disclaimers:

•    Flexible work schedule is based on job duties, department, organization, or business need.

•    Gold Coast Health Plan will not sponsor applicants for work visas.

POSITION SUMMARY

The Gold Coast Health Plan (GCHP) Care Management Coordinator I (CMC I) plays a critical role in Processing and screening referrals, successful coordination of care for members to promote effective education, self-management support and timely heath care delivery to achieve optimal quality and positive outcomes. Working under the direction of Nurse and Social Worker Care Managers, the CMC I helps facilitate the processing of cases and acts as a conduit of information both interdepartmentally and within the community. The CMC I is responsible for working in tandem with the Care Manager (CM) in the collaborative development and ongoing maintenance of individualized care plans using available clinical, social and functional data. The Care Manager develops the plan of care with the member while the CMC I supports the care plan by completing tasks that are auto-generated or assigned to them by a Care Manager. The CMC I may direct members to available resources and educate patients on a wide range of programs and options available to them to facilitate effective Care Management across the Continuum of Care.

Reasonable Accommodations Statement

To accomplish this job successfully, an individual must be able to perform, with or without reasonable accommodation, each essential function satisfactorily. Reasonable accommodations may be made to help enable qualified individuals with disabilities to perform the essential functions.

ESSENTIAL FUNCTIONS

Job Function & Responsibilities

•    Assists assigned team, nurse or social worker with the coordination of health care activities for GCHP members

•    Conducts telephone interviews with member, significant others and family members to determine if care needs are being met or if additional services are needed

•    Receive Enhanced Care Management (ECM) and Community Supports (CS) authorization requests via fax and enters data into the medical management system to create a service request and assign to the clinical team 

•    Review and reply to inquires received the CalAIM inbox

•    Return phone calls received in the CalAIM hotline to providers, members, and community partners regarding ECM and CS services

•    Educate members on the use of Medically Supportive Foods/Medically Tailored Meals and assist with changing meal provider

•    Review incoming Medically Supportive Foods/Medically Tailored Meals referrals to ensure appropriate diagnosis or chronic condition is provided before sending for clinical review

•    Facilitate ECM and CS referrals for members as needed

•    Collaborate with GCHP clinical Care Managers regarding member ECM and CS enrollment status. 

•    Create Case management program referrals 

•    Ability to stay calm and professional and maintaining clear and concise communication with internal and external partners 

•    Ability to convey empathy and is nonjudgmental of the member

•    Attends collaborative meetings with community partners as assigned

•    Document all contacts with members and providers in the appropriate medical management system using the standard charting format

•    Demonstrate GCHP core values: In