DEPARTMENT(S):  Case Management REPORTS TO:  Supervisor, Case Management FLSA STATUS:  Non-Exempt SALARY GRADE:  C - $41,000 - $53,000

This position will support the members in completing their health risk assessment (HRA). The Personal Care Coordinator (PCC) will ensure communication of the member’s HRA and care plan with the member, Primary Care Provider (PCP), and health care team. The position will identify barriers to member’s care and assist in improving these barriers for all levels of care. The incumbent will work closely with the PCP and health care team to ensure member access to timely services and coordination of care.

POSITION RESPONSIBILITIES:

• Performs outreach to members to coordinate completion of the initial and annual health risk assessment (HRA), conducts telephonic HRASs as necessary and ensures data entry of HRAs received via email.
• Collaborates with PCP and health care team to ensure timely communication of member’s clinical information.
• Partners with licensed professionals in the development of an initial care plan for each member, incorporating the HRA and all assessment findings.
• Facilitates communication of initial care plan to the PCP and member, as necessary.
• Maintains documentation of member’s case, care plan, interventions, and interdisciplinary care team within CalOptima’s medical management system.
• Identifes the need for, and facilitates, referrals to Long Term Support Services (LTSS), Behavioral Health and community resources.
• Oversees warm transfers to member’s assigned case manager in accordance with member needs, when appropriate.
• Guides members in understanding and accessing the benefits they are entitled to under Medi-Cal.
• Notifies member’s care team of key event triggers.
• Maintains compliance with established departmental productivity guidelines.
• Ensures reporting of productivity metrics to supervisor as required.
• Other projects and duties as assigned.

KNOWLEDGE & ABILITIES: 

• 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.
• Develop rapport and establish and maintain effective interpersonal relationships with internal and external contacts at all levels.
• Work with Case Management staff to expedite the resolution of member concerns.
• Communicate clearly and concisely, both verbally and in writing with individuals from a diverse population.
• Speak, understand, read and/or write a second language in addition to English as it may be required for some assignments.
• Utilize and access computer and appropriate software (e.g., Microsoft Office; Word, Excel, PowerPoint) and job-specific applications/systems to produce correspondence, data entry, and/or other information applicable to the position.

EXPERIENCE & EDUCATION:

• High school degree or equivalent required.
• 2+ years experience working with the needs of Seniors or persons with disabilities (SPD) in a customer/member service capacity required.
• Bilingual in English and one of CalOptima’s defined threshold languages (Spanish, Vietnamese, Arabic, Farsi, Korean, or Chinese) is required.

PREFERRED QUALIFICATION:

• Bachelor’s degree in Healthcare Management or related field preferred.
• 1+ year HMO, Medi-Cal and/or Health Services experience preferred.

KNOWLEDGE OF:

• Principles and practices of health care service delivery and managed care, Medi-Cal, CalOptima eligibility and benefits.
• Long term services and supports.
• Issues that face members with special needs, such as seniors and persons with disabilities.
• Principles and techniques to serve the SPD population in diverse social and ethnic groups.

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.

If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability.  You can request reasonable accommodations by contacting Human Resources Disability Management at 657-900-1134.

Required Skills Required Experience