POSITION SUMMARY
Will identify and coordinate resources to assist members in the transition back to living in the community and to live as independently as possible. Will also visit CHG members in their home, Assisted Living Facilities, and/or Long Term Care Facilities.
RESPONSIBILITIES
Will work in close collaboration with CHGs Interdisciplinary Care Team and contracted physician groups who conduct assessments to establish care needs.
Will visit members in their homes and/or treatment facilities; approximately 50% of time devoted to work outside of the office.
Work with identified members to assess their care needs.
Interview all prospective members who have indicated an interest in returning to the community.
Make referrals to available resources in the community.
Develop strong linkages with community-based health care providers to promote quality and availability of services.
Facilitate, promote, and advocate for the member’s ongoing self-sufficiency and independence.
Educate members within a nursing facility on home and community-based alternatives and assess the member’s potential for and interest in transitioning from the facility to the community.
Facilitate and execute specific interventions to ensure the member’s health, safety, and welfare.
Organize, integrate, and modify resources needed to establish the plan of care for each member.
Provide resource information and education regarding the community-based needs of our members.
Be available to members, family members/informal supports, and legal guardians to answer questions.
Support a member’s right to be the decision-maker regarding life goals, activities, services, and providers.
EDUCATION
Bachelors degree in a health-related field (i.e., social work, social welfare, psychology, or health education).
EXPERIENCE/SKILLS
Minimum 3 years experience in managed care experience preferred.
Ability to communicate effectively both in-person and in writing.
Bilingual (English/Spanish preferred; or English/Vietnamese, English/Arabic, English/Tagalog).
Knowledge of community health and social service agencies and additional community resources.
Exceptional customer services, communication, and interpersonal skills with the ability to quickly build rapport.
Ability to work with minimal supervision within the role and scope.
Ability to use a variety of electronic information applications/software programs including electronic medical records.
Intermediate to Advanced computer skills and experience with Microsoft Word, Outlook, and Excel.
Reliable transportation with current California driver’s license and proof of auto insurance.
Previous care coordination experience to Medi-Cal (Medicaid) and/or Medicare recipients receiving long-term care and/or home and community-based services.
Previous managed care and/or long-term care experience.
Experience working with the geriatric population.
Experience with health promotion, coaching, and wellness.
PHYSICAL REQUIREMENTS
Prolong periods of sitting
Driving within San Diego County
Lifting of no more than 10 lbs.
Qualifications
EDUCATION
Bachelor’s degree in a health related field (i.e., social work, social welfare, psychology, or health education).
EXPERIENCE/SKILLS
Minimum 3 years’ experience in managed care experience preferred.
Ability to communicate effectively both in person and in writing.
Bilingual (English/Spanish preferred; or English/Vietnamese, English/Arabic, English/Tagalog).
Knowledge of community health and social service agencies and additional community resources.
Exceptional customer services, communication and interpersonal skills with the ability to quickly build rapport.
Ability to work with minimal supervision within the role and scope.
Ability to use a variety of electronic information applications/software programs including electronic medical records.
Intermediate to Advanced computer skills and experience with Microsoft Word, Outlook, and Excel.
Reliable transportation with current California driver’s license and proof of auto insurance.
Previous care coordination experience to Medi-Cal (Medicaid) and/or Medicare recipients receiving long-term care and/or home and community based services.
Previous managed care and/or long-term care experience.
Experience working with the geriatric population.
Experience with health promotion, coaching and wellness.
PHYSICAL REQUIREMENTS
Prolong periods of sitting
Driving within San Diego County
Lifting of no more than 10 lbs.
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