Responsible for case management of members and their families in obtaining and understanding services and programs available through the Enhanced Care Management (ECM) program
Conduct comprehensive assessments to determine the physical, emotional, and social needs of members
Develop individualized care plans based on assessment findings, considering medical history, preferences, and specific needs
Tailor care plans to individual needs and goals
Coordinate and facilitate communication between healthcare providers, social workers, therapists, and other members of the care team to ensure a comprehensive and integrated approach to care
Collaborate with Medical Doctors, Clinical Consultants, Housing Navigators and Leaders to make recommendations tailored to member needs
Monitor the progress of members and update care plans as needed per policy and compliance requirements
Ensure prescribed treatments and interventions are being followed and communicate to PCP and specialty care providers any significant changes to member concerns along with any updates on member status
Provide positive member client service experience through multiple support channels including telephone and in-person
Maintain accurate and up-to-date records of assessments, care plans, and interactions with members
Ensure compliance with relevant regulations and standards
Complete all required documentation accurately, in a timely manner and in accordance with company standards
Provide leaders with case progress periodically/required basis
Advocate for patients or clients, helping them navigate the healthcare system, understand their treatment options, and access the services they require
Provide education to members and their families on health-related topics, treatment options, and self-care strategies
Identify and connect members with appropriate community resources, support services, and programs to address their needs, such as housing assistance, financial aid, or counseling services
Plan and coordinate the discharge process for members leaving hospitals or long-term care facilities, ensuring a smooth transition to home or another care setting
Participate in training new employees
Perform other duties as assigned or required per departmental policy
Travel to members within assigned San Benito & Monterey County regions; 30% remote work and 70% in-person visits
Requirements
Fluent in English (written and verbal)
Bilingual in Spanish
Competent with computers, email, virtual platforms, Excel and other Microsoft Office based programs
Prior use of Electronic Medical Records
Excellent verbal and written communication skills
Ability to identify problems and use logic and related information to develop and implement solutions
Ability to work independently and carry out assignments to completion within the parameters of established policies and procedures
Operate a computer and other office equipment such as a telephone, calculator, copy machine, and printer
Must be able to remain in a stationary position 30% of the time
Must be able to move around the office or community 70% of the time
Move or carry office equipment weighing up to 15 pounds across offices
Ability to operate a vehicle and travel
Associate degree
2 years of healthcare or care coordination experience
Current and valid Driver’s License
Proof of auto insurance
Current BLS certification from the American Heart Association upon start date
Current TB test
Distraction-free home workspace with a secure internet connection
Nice to haves: Prior experience in MA, CNA, home health, case management, care coordination, hospice, or other health-related field preferred
Nice to haves: Previous exposure to pediatric populations