Personal Care Coordinator Sr.

Company: SUNSHINE ENTERPRISE USA LLC
Location: Orange
Posted on: September 1, 2024

Job Description:

Company Overview: Our client is a leading healthcare located in Orange, CA, seeking personal care coordinator sr. Position Summary: The successful candidate should hold a current, unrestricted Licensed Medical Nurse (LVN) license with 3 years of nursing experience, 1 year as a Clinical Nurse Reviewer along with 1 year of utilization management/prior authorization review experience. Work Duration: Up to 6 months Work type: On-site Position Responsibilities:

• Maintains strong working relationships when collaborating with the PCP and health care team to ensure timely communication of member's clinical information and ensures appropriate documentation of all interventions. Also, notifies member's care team of key event triggers.
• Collaborates with licensed professionals in development of a care plan for each member, incorporating the HNA or HRA all assessment findings. Facilitates communication of care plan to the PCP and member, as necessary.
• Develops and implements a member's specific care plan which includes prioritized Specific, Measurable, Achievable, Relevant, and Time-Bound (SMART) goals.
• Facilitates and participates in interdisciplinary team meetings as applicable.
• Processes and maintains complex or sensitive documentation of member's case and care plan within the medical management system.
• Facilitates referrals to Behavioral Health Services and identifies the need for referrals to Long-Term Support Services and community resources.
• Facilitates transfers to member's assigned case manager in accordance with member needs, when appropriate.
• Anticipates longer-term and more unique member needs by providing guidance in understanding and accessing the benefits they are entitled to under Medicare and Medi-Cal, as appropriate.
• Maintains compliance with established departmental productivity guidelines; compiles and conducts basic analyses and reporting of productivity metrics to management as required.
• Coordinates and maintains cases in current case load in accordance with case management standards. Assists with collection of health risk or health needs assessments as well as gathers medical records as needed.
• Provides regular outreach to assigned members and evaluates quality of service given to members according to department contact standards.
• Serves as the main point of contact for assigned members to anticipate longer term member needs.
• Works with Case Management staff to expedite the resolution of member concerns.
• Complete additional assignments and projects as assigned. Experience & Education:
  • High School diploma or equivalent required PLUS 2 years of experience working with the needs of members, such as but not limited to pediatric members, seniors, behavioral health conditions, substance use disorders or persons with disabilities (SPD) and/or special populations (e.g., homeless or at risk of homelessness) in a customer/member service capacity required.
  • Bachelor's degree in healthcare management, social work, human services or related field preferred
  • 2 years of experience with health maintenance organization (HMO), Medi-Cal and health services required.
  • Bilingual in English and one of languages (Arabic, Chinese, Farsi, Korean, Spanish, or Vietnamese) preferred. Necessary Attributes:
    • Establish effective relationships with internal and external stakeholders.
    • Demonstrate independent judgment and decision-making skills.
    • Communicate effectively both verbally and in writing.
    • Flexible schedule availability for evening and weekend events.
    • Strong organizational, analytical, and problem-solving abilities.
    • Proficiency in Microsoft Office (Word, Outlook, Excel, PowerPoint) and job-specific applications/systems. Please see HR for information on physical demands and work environment of this job. Sunshine Enterprise USA is an "Equal Opportunity Employer-Minorities, Females, Veterans and Disabled Persons"
      
      Compensation details: 28-38 Hourly Wage
      
      
      
      PI4d119cfebe04-37248-35375342

Keywords: SUNSHINE ENTERPRISE USA LLC, Orange , Personal Care Coordinator Sr., Other , Orange, California