DEPARTMENT(S): Case Management
REPORTS TO: Supervisor, Case Management
FLSA STATUS: Non-Exempt
SALARY GRADE: C - $41,000 - $53,000
JOB SUMMARY
The incumbent will support members and families of children with special health care needs in the completion of a Health Needs Assessment (HNA) and development of an initial care plan. The Personal Care Coordinator (PCC) will ensure communication of the member’s HNA and care plan with the member, Health Network (HN), and health care team. The Personal Care Coordinator will identify barriers to members’ care and develop and make recommendations for comprehensive care plans at all levels of care. The incumbent will work with the health networks to ensure member access to timely services and coordination of care. The PCC will work with the member, family, and other members of the member’s health care team to implement a member-centered care plan.
POSITION RESPONSIBILITIES:
- Manages a panel of members independently, assisting members with health care access and proactively working with them to achieve their healthcare goals.
- Collaborates with health networks to ensure timely communication of members’ clinical information.
- Performs outreach to members to coordinate completion of the initial and annual HNA.
- Collaborates with licensed professionals in the development of an initial care plan for each member by incorporating the HNA and all assessment findings.
- Facilitates communication of initial care plan to the Primary Care Physician (PCP), health network, and member, as necessary.
- Maintains documentation of member’s case, care plan, and interdisciplinary care team within CalOptima’s medical management system.
- Facilitates referrals to behavioral health services.
- Identifies member needs and assists members with referrals to community resources to meet those needs.
- Works with member’s assigned case manager in accordance with members’ needs to facilitate necessary care.
- Collaborates with health care team members to implement each member’s care plan.
- Guides members in understanding and accessing the benefits they are entitled to under Medi-Cal and California Children’s Services (CCS).
- Notifies members’ care team of key event triggers.
- Other projects and duties as assigned.
POSSESSES THE ABILITY TO:
- Maintain accurate records and documentation.
- Interview members to determine strengths, problems, functional status, goals, and need for specific services/resources.
- Contribute to the development of a plan based on assessment of the member’s physical, psychosocial, functional, strengths/barriers, and mental health needs.
- Establish and maintain effective working relationships with CalOptima leadership and staff.
- Demonstrate strong customer service skills.
- Work with Case Management staff, California Children’s Services (CCS), and other members of the health care team to facilitate medical care and expedite the resolution of member concerns.
- Communicate clearly and concisely, both verbally and in writing with individuals from varying cultural and ethnic backgrounds.
- Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment.
EXPERIENCE & EDUCATION:
- High school diploma or equivalent required.
- 2 years of experience working with the needs of pediatric members in a member service capacity required.
- Bilingual in English and one of CalOptima’s defined threshold languages (Spanish, Vietnamese, Arabic Farsi, Korean, Chinese) is required.
PREFERRED QUALIFICATIONS:
- Bachelor’s degree in Health Care Management, Social Work, Human Services, or related field preferred.
- Health Maintenance Organization (HMO), Medi-Cal, and Pediatric Health services experience preferred.
KNOWLEDGE OF:
- Medi-Cal eligibility and benefits.
- Issues that impact members and families of children with special health care needs.
- Health care service delivery and managed care, Medi-Cal/Medicare, CalOptima eligibility and benefits.
- Principles and techniques to serve the pediatric population in diverse social and ethnic groups.
- Effective charting practices and guidelines.
CalOptima is an equal employment opportunity employer and makes all employment decisions on the basis of merit. CalOptima wants to have qualified employees in every job position. CalOptima prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics.
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Required Skills
Required Experience