Maintain ongoing caseload of individuals through the utilization of evidence based approaches to promote engagement and achievement of health goals
Use relationship-based strategies to support members with social support navigation, understanding that many may have lived personal experiences causing them to be initially hesitant or distrusting of the health care system
Conducts periodic telephonic and SMS outreach to ensure timely follow-up to members
Work with member to identify health/wellness goals and incorporate goals into Health Action Plan/Shared Care Plan
Supports nurse care manager, behavioral health care manager, nurse practitioner and Community Engagement Specialist with delegated tasks
Collaborates on care issues with Enhanced Care Management team by participating in systematic case reviews and consulting with nurse care manager, behavioral health care manager, and nurse practitioner before taking clinical actions
Consistently meet monthly encounter metrics to ensure compliance with health plan regulations
Identify and break down barriers ensuring individuals’ continuation with the program
Assists individuals in securing connection to community supports by scheduling appointments, managing referrals, and ensuring timely follow-ups
Coordinate physical care management appointments through collaboration with external and internal providers
Utilize external and internal online platforms to collaborate with team members and carry out daily tasks
Requirements
1+ years of general work experience (Case Management preferred)
You are physically located in California
Field Ops requires you to maintain reliable transportation for engagement at clinic, community based organization, and health system partner locations
Virtual Ops requires a quiet, HIPAA compliant and internet connected space
Bilingual – English/Spanish
Strong understanding of cultural fluency
High degree of empathy
Ability to work collaboratively in a multidisciplinary team
An eye for optimization
Organizational skills
Ability to remain patient when faced with adversity
Strong technical skills and comfort with technology innovation, past experience with CRM databases, basic Excel, Word, email, and video conferencing
A valid driver’s license and auto liability insurance