The incumbent 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 Personal Care Coordinator (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:
- Manages a panel of members independently, assisting members with health care access and proactively working with them to achieve their healthcare goals
- 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 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.
- Facilitates referrals to behavioral health services.
- Identifies member needs and assists members with referrals to community resources to meet those needs.
- Works with member’s assigned case manager in accordance with members 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.
Required Skills
- Maintain accurate records and documentation.
- 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, 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 clearly and concisely, both verbally and in writing with individuals from varying cultural and 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.
Required Experience
EXPERIENCE & EDUCATION:
- High school diploma or equivalent required. Bachelor’s degree preferred.
- 2 Years of 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.
- 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