Care Management Coordinator II

Gold Coast Health Plan will not sponsor applicants for work visas.

The pay range above represents the minimum and maximum rate for this position in California. Factors that may be used to determine where newly hired employees will be placed in the pay range include the employee specific skills and qualifications, relevant years of experience and comparison to other employees already in this role. Most often, a newly hired employee will be placed below the midpoint of the range. Salary range will vary for remote positions outside of California and future increases will be based on the pay band for the city and state you reside in.

POSITION SUMMARY

The Gold Coast Health Plan (GCHP) Care Management Coordinator II (CMC) plays a critical role in successful coordination of care for members to promote effective education, self-management support and timely heath care delivery to achieve optimal quality and positive outcomes. Working under the direction of Nurse and Social Worker Care Managers, the CMC II helps facilitate the processing of cases and acts as a conduit of information both interdepartmentally and within the community. The CMC II is responsible for working in tandem with the Care Manager in the collaborative development and ongoing maintenance of individualized care plans using available clinical, social and functional data. The Nurse Care Manager develops the plan of care with the member while the CMC II routinely reviews and maintains the care plan in order to assist the process. The CMC II may direct members to available resources and educate patients on a wide range of programs and options available to them to facilitate effective Care Management across the Continuum of Care.

Amount of Travel Required: 5-15%

Work Schedule: Travel to multiple sites and different locations. Flexibility to work beyond normal business hours as needed.

Reasonable Accommodations Statement

To accomplish this job successfully, an individual must be able to perform, with or without reasonable accommodation, each essential function satisfactorily. Reasonable accommodations may be made to help enable qualified individuals with disabilities to perform the essential functions.

ESSENTIAL FUNCTIONS

Essential Functions Statements

•    Assists assigned team, nurse or social worker with the coordination of health care activities for GCHP members

•    Conducts telephone interviews with member, significant others and family members to determine if care needs are being met or if additional services are needed

•    Creates and processes program referrals

•    Conducts telephone interviews with members, family members and significant others 

•    Prioritizes and collaborate with CM partner to assist with meeting the member’s needs.

•    Schedules assessments; coordinates and obtains medical records, ensuring processes are completed within regulatory timelines

•    Documents all interventions, follow up information and communication with members in the members EMR

•    Participates in interdisciplinary team conferences as needed

•    Utilizes documentation tracking system to complete tasks 

•    Provides non-clinical support to Care Managers 

•    Establishes telephonic, electronic correspondence and/or fax contact with internal and external customers following internal policies and HIPAA guidelines

•    Demonstrates GCHP Core Values: Integrity, Accountability, Respect, Collaboration, Trust

•    Attends collaborative meetings with community partners as assigned

•    Maintains productivity standards

•    Both verbal and written communication with members, providers, and community partners are clear and concise.

•    Ability to convey empathy and is nonjudgmental of the member

•    Demonstrates team support by consistently seeking opportunities to recognize and promote colleagues

•    Ability to stay calm and professional when working with internal and external partners.

•    Ability to multi-task, both with and without supervision, with attention to detail 

•    Critical thinking skills as demonstrated by the ability to problem-solve complex, multifaceted situations

•    Strong organizational and prioritization skills.

•    Strong computer skills on Microsoft Office products and data base programs (Word and Excel, Microsoft Access a plus).

•    Strong written and verbal communication skills

•    Patient advocacy focus.

•    Develops positive working relationships with external and internal customers

•    Works collaboratively with external and internal customers

•    Exhibits accountability by maintaining good attendance

•    Acts as a role model for staff in all areas including attendance and punctuality

•    Promotes teamwork by routinely offering assistance to others

•    Consistently exceeds productivity standards

•    Provides first line back up support to CMC III

•    Functions as a preceptor to new staff 

•    Audit scores consistently exceed standard 

•    Performs department audit activities as assigned

•    Contributes toward the development of Care Management Procedures such as workflows, JAM, and resource tools.

•    Identifies improvement opportunities in work processes to improve department efficiency and efficacy and collaborates with Management in the development and/or revision of Job Aids and workflows

•    Demonstrates in-depth knowledge of current policies, job aids and workflows 

•    Performs system testing as assigned

•    Independently and actively seeks opportunities for educational advancement related to position 

•    Completes additional job duties as assigned by the department Director/Manager/CMC III

•    Other duties as assigned by manager/director

POSITION QUALIFICATIONS

Competency Statements

•    Customer Oriented - Ability to take care of the customers" needs while following company procedures.

•    Active Listening - Ability to actively attend to, convey, and understand the comments and questions of others.

•    Accuracy - Ability to perform work accurately and thoroughly.

•    Communication, Oral - Ability to communicate effectively with others using the spoken word.

•    Communication, Written - Ability to communicate in writing clearly and concisely.

•    Decision Making - Ability to make critical decisions while following company procedures.

•    Ethical - Ability to demonstrate conduct conforming to a set of values and accepted standards.

•    Organized - Possessing the trait of being organized or following a systematic method of performing a task.

•    Responsible - Ability to be held accountable or answerable for one’s conduct.

•    Self Motivated - Ability to be internally inspired to perform a task to the best of ones ability using his or her own drive or initiative.

•    Accountability - Ability to accept responsibility and account for his/her actions.

SKILLS & ABILITIES

Education: High School Graduate or General Education Degree (GED): Required

Experience:    

•    Previous experience in Care Management required

•    Ability to speak, read, and write in English and Spanish is necessary for certain positions

•    For internal candidates, applicant must be in good performance standing for at least 1 year

Computer Skills:        

•    Strong computer skills on Microsoft Office products and data base programs (Word, Excel, Outlook, Teams, PowerPoint would be a plus)

•    Ability to type at least 45 words per minute