santa clara family health plan
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Medical Management Personal Care Coordinator
at santa clara family health plan
Santa Clara Family Health Plan - San Jose, CA 95119
# of Openings:
FLSA Status: Non-Exempt
Department: Health Services
Reports To: Health Services Management
Salary: $25.79 - $38.69
Employee Unit: Employees in this classification are represented by Service Employees International Union (SEIU) Local No. 521
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 perform each essential duty listed below satisfactorily.
- 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.
- Monitor and respond to inbound case management inquiries and referrals and escalate to clinical staff, as appropriate.
- Provide outreach to members to facilitate timely completion of Health Risk Assessments (HRA’s) by telephone, mail or in person, as needed.
- 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.
- 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.
- 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.
- 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.
- Produce and distribute internal reports that may include QI reports and member admission and discharge reports, as appropriate.
- 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.
- Maintain knowledge of current resources in communities served by our members to support case management goals.
- Develop effective and professional working relationships with internal and external stakeholders and partners. Communicate effectively with members and providers orally and in writing.
- 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.
- 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.
- Collaborate with team members on improvement efforts across-departments regarding quality improvement projects, optimization of utilization management, and member satisfaction.
- Attend and actively participate in daily, weekly, and monthly departmental meetings, in-services, training and coaching sessions.
- .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.
- Bachelor's Degree in a health related field or equivalent experience, training or coursework. (R)
- Minimum three years of relevant experience in a healthcare or community setting providing care coordination of health and/or social services. (R)
- 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)
- Knowledge of Medicare and/or Medi-Cal benefits, community resources and principals of case management. (D)
- Spanish, Vietnamese, Chinese, or Tagalog language bi-lingual skills. (D)
- Knowledge of medical terminology. (D)
- Knowledge of Santa Clara County Health and Social Services. (D)
- 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)
- Ability to consistently meet accuracy and timeline requirements to maintain regulatory compliance. (R)
- Ability to work within an interdisciplinary team structure. (R)
- Working knowledge of and the ability to efficiently operate all applicable computer software including computer applications such as Outlook, Word, Excel, and specific case management programs. (R )
- Ability to use a keyboard with moderate speed and a high level of accuracy. (R)
- Excellent communication skills including the ability to express oneself clearly and concisely when providing service to SCFHP internal departments, members, providers and outside entities over the telephone, in person or in writing. (R)
- Ability to think and work effectively under pressure and accurately prioritize and complete tasks within established timeframes. (R)
- Ability to assume responsibility and exercise good judgment when making decisions within the scope of the position. (R)
- Ability to maintain confidentiality. (R)
- Ability to comply with all SCFHP policies and procedures. (R)
- Ability to perform the job safely and with respect to others, to property and to individual safety. (R)
Generally, duties are primarily performed in an office environment while sitting or standing at a desk. Incumbents are subject to frequent contact with and interruptions by co-workers, supervisors, and plan members or providers in person, by telephone, and by work-related electronic communications.
Incumbents must be able to perform the essential functions of this job, with or without reasonable accommodation:
- Mobility Requirements: regular bending at the waist, and reaching overhead, above the shoulders and horizontally, to retrieve and store files and supplies and sit or stand for extended periods of time; (R)
- Lifting Requirements: regularly lift and carry files, notebooks, and office supplies that may weigh up to 5 pounds; (R)
- Visual Requirements: ability to read information in printed materials and on a computer screen; perform close-up work; clarity of vision is required at 20 inches or less; (R)
- Dexterity Requirements: regular use of hands, wrists, and finger movements; ability to perform repetitive motion (keyboard); writing (note-taking); ability to operate a computer keyboard and other office equipment (R)
- Hearing/Talking Requirements: ability to hear normal speech, hear and talk to exchange information in person and on telephone; (R)
- Reasoning Requirements: ability to think and work effectively under pressure; ability to effectively serve customers; decision making, maintain a concentrated level of attention to information communicated in person and by telephone throughout a typical workday; attention to detail. (R)