DEPARTMENT(S): Case Management
REPORTS TO: Manager, Case Management
FLSA STATUS: Non-Exempt
SALARY GRADE: C - $41,000 - $53,000
JOB SUMMARY
This position will support CalOptima most vulnerable members including those experiencing homelessness. The incumbent will identify and assist in addressing barriers to members’ care via telephone and face to face interactions. The incumbent will work closely with the Primary Care Provider (PCP), health care team and/or health network, as applicable, to coordinate care and support the members’ timely access to CalOptima covered services.
POSITION RESPONSIBILITIES:
- The incumbent will ensure timely follow up with members seen by the Clinical Field Teams and members identified as needing housing support.
- The incumbent will provide outreach services at shelters, community-based organizations, and designated events to provide education and support to members. The incumbent will assess member needs using a standardized Health Needs Assessment (HNA) requests from health care providers and members with respect to CalOptima covered services.
- Provide telephone or face to face support to members treated by Clinical Field Team.
- Provide outreach and education to members in offsite locations including shelters, community-based organizations, and assigned events.
- Coordinate care and services with members including face-to-face meetings at settings outside of CalOptima locations.
- Collaborate with PCP, health network and health care team to ensure timely communication of members’ clinical and service needs information, as appropriate.
- Appropriately document all interventions.
- Facilitate referrals to Case Management, behavioral health services and other support services providers, as needed.
- Identify need for referrals to Long Term Support Services (LTSS) and community resources, as needed.
- Facilitate warm transfers to members’ assigned CalOptima or health network case manager in accordance with member needs, when appropriate.
- Guide members in understanding and accessing the benefits they are entitled to under Medi-Cal and Medicare.
- Notify members’ care team of key event triggers.
- Maintain compliance with established departmental productivity guidelines.
- Ensure reporting of productivity metrics to supervisor as required.
- Other projects and duties as assigned.
POSSESSES THE ABILITY TO:
- 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 the member care plan based on assessment of the members’ 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.
- Work with Case Management, health network, provider staff and community-based organizations to expedite the resolution of member concerns.
- Communicate effectively, both verbally and in writing, with individuals from varying clinical/nonclinical and cultural/ethnic backgrounds.
- Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment.
EXPERIENCE & EDUCATION:
- High school diploma or equivalent required.
- 2+ years experience working with the needs of persons who are homeless or at risk of homelessness required.
- Valid driver’s license and vehicle, or other approved means of transportation, an acceptable driving record, and current auto insurance will be required for work away from the primary office 20% of the time or more.
PREFERRED QUALIFICATIONS:
- Bachelor’s degree in Social Work or related field preferred.
- Experience working with individuals with behavior health conditions or substance use disorders preferred.
- HMO, Medi-Cal and Medicare and health services experience preferred.
- Bilingual in English and one of CalOptima’s defined threshold languages (Spanish, Vietnamese, Arabic, Farsi, Korean, and Chinese) is preferred.
KNOWLEDGE OF:
- Medi-Cal/Medicare eligibility and benefits.
- Long term services and support.
- Issues that face members who are homeless or at risk of homelessness and who have behavioral health conditions or substance use disorders.
- Principles and practices of health care service delivery.
- Principles and techniques to serve the homeless population in diverse social and ethnic groups.
- Effective charting practices and guidelines.
- Computers, keyboarding, and appropriate software to produce correspondence, data entry, and/or other information applicable to the position.
CalOptima is an equal employment opportunity employer and makes all employment decisions on the basis of merit. CalOptima wants to have qualified employees in every job position. CalOptima prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics.
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Required Skills
Required Experience