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Personal Care Coordinator (Whole Child Model) (5 Openings)

Company: CalOptima
Location: Orange
Posted on: November 3, 2018

Job Description:

This position will support members and families of children with special health care needs in the completion of a Health Needs Assessment (HNA) and development of an initial care plan. The Personal Care Coordinator (PCC) will ensure communication of the member?s HNA and care plan with the member, Health Network (HN), and health care team. The PCC will identify barriers to member?s care and develop and make recommendations for comprehensive care plans at all levels of care. The incumbent will work with the health networks to ensure member access to timely services and coordination of care. The PCC will work with the member, family, and other members of the member?s health care team to implement a member centered care plan.?Position Responsibilities:

  • Collaborates with health networks to ensure timely communication of member?s clinical information.
  • Performs outreach to members to coordinate completion of the initial and annual health needs assessment (HNA).
  • Collaborates with licensed professionals in the development of an initial care plan for each member by incorporating the HNA and all assessment findings.
  • Facilitates communication of initial care plan to the primary care physician (PCP), health network and member, as necessary.
  • Maintains documentation of member?s case, care plan and interdisciplinary care team within CalOptima?s medical management system.
  • Facilitate referrals to behavioral health services.
  • Identify member needs and assist member with referrals to community resources to meet those needs.
  • Works with member?s assigned case manager in accordance with member needs to facilitate necessary care.
  • Collaborates with health care team members to implement each member?s care plan.
  • Guides members in understanding and accessing the benefits they are entitled to under Medi-Cal and California Children?s Services (CCS).
  • Notifies member?s care team of key event triggers.
  • Other projects and duties as assigned.
    • Maintain accurate records and documentation.
    • Effectively 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.
    • Demonstrate strong customer service skills.
    • Work with Case Management staff, California Children?s Services (CCS), and other members of the health care team to facilitate medical care and expedite the resolution of member concerns.
    • Remain knowledgeable of the health networks, and Medi-Cal benefit structure.
    • Communicate effectively, both verbally and in writing with individuals from varying cultural and ethnic backgrounds.
    • Speak, understand, read and/or write a second language in addition to English is required.Experience & Education:
      • High school diploma or equivalent required.
      • Bachelor?s degree preferred.
      • 2+ years experience working with the needs of pediatric members in a member service capacity required.
      • HMO, Medi-Cal, and pediatric health services experience preferred.
      • Bilingual in English and one of CalOptima?s defined threshold languages is required.Knowledge of:
        • Medi-Cal eligibility and benefits preferred.
        • Issues that impact members and families of children with special health care needs .
        • Principles and practices of health care service delivery and managed care, Medi-Cal/Medicare, CalOptima eligibility and benefits.
        • Principles and techniques to serve the pediatric population in diverse social and ethnic groups.
        • Effective charting practices and guidelines.
        • Computers, keyboarding, and appropriate software to produce correspondence, charts, spreadsheets, and/or other information applicable to the position.Grade:? I#CB

          Keywords: CalOptima, Orange , Personal Care Coordinator (Whole Child Model) (5 Openings), Other , Orange, California

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