Job Summary

The Care Management Coordinator II is responsible for outreach to members/caregivers, providers, Community Based Organizations (CBO), and others to help enroll our highest need members into the Care Management (CM), and Disease Management (DM) programs. The position is responsible to assess member’s strengths, challenges, needs, and barriers to care through conducting telephonic Health Risk Assessment (HRA). The position works with the member/caregiver, Care Management Specialist, Community Health Worker, and the Interdisciplinary Care Team (ICT) to support the development and implementation of the care plan and address unmet needs.

This position coordinates the flow of information between the CM team and the member/caregiver, provider, medical group, and other members of the ICT. The position supports the coordination of member care as instructed by the Care Management Specialist and outlined in the care plan including the reinforcement of health education and disease management information; coordinating benefits such as transportation and DME; and linking member to community resources to address the Social Determinants of Health (SDoH) of the member. The position is responsible to ensure the CM team meets the contractual and regulatory requirements and timelines by maintaining accurate documentation and following up with the member and provider as needed.

In addition, this position is assigned projects to support the department in meeting its regulatory and contractual requirements, such as running reports, data validation, quality checks and other projects. The position assists with the communication and coordination between programs and maintains confidentiality when communicating member information.

Duties

Responsible for the time sensitive processes for initiating cases, managing referrals to the department, appropriate documentation, routing of information, performing computer data input, faxing, emailing, filing of confidential member information, and maintaining logs of activity, etc. (40%) 

Engages members to participate in the CM/Disease Management programs by reaching out and promoting the programs to address member’s unmet needs. (10%)

Completes telephonic calls to conduct the HRA with high risk members participating in the CM program. Assists the care team with developing and assessing health interventions. (10%)

Conducts telephonic outreach calls to members/caregivers regularly and evaluates and documents their progress towards their healthcare goals. Consults and collaborates with the Care Management Specialist to set up provider/specialist appointments and follow up on treatment plans. (10%)

Handles the incoming and outgoing calls to members/caregivers and providers to coordinate care as identified in the care plan. (10%)

Initiates follow up calls to members to administer screenings or confirm linkage to appropriate resources. Provides general information to members and providers about the CM and DM programs.  (10%)

Performs other duties as assigned. (10%)

Duties Continued

Education Required

Education Preferred

Experience

Required:
At least  6 months of  experience in an administrative and customer service role in a health care/health services setting . 

Preferred:  
1 year of Medical Assistant experience.                                                                                                             
6 months of experience processing authorizations at a managed care/health plan setting. 

Skills

Required:
Knowledge of medical terminology

Strong verbal and written communication skills

Proficiency in Microsoft Office with a high level of accuracy

Excellent organizational, and time management skills

Detail-oriented and a team player

Excellent customer service skills with compassion and empathy

Ability to demonstrate sensitivity and respect for the opinions, perspectives, customs, and individual differences of others. 

Ability to value diversity of people and ideas, as well as interact  with people from a wide range of backgrounds.  

Ability to be  flexible, open-minded, listen to and consider others’ viewpoints. 

Ability to work well and develop effective relationships with diverse personalities.

Preferred:
Bilingual in one of L.A. Care Health Plan’s threshold languages is highly desirable. English, Spanish, Chinese, Armenian, Arabic, Farsi, Khmer, Korean, Russian, Tagalog, Vietnamese.

Licenses/Certifications Required

Licenses/Certifications Preferred

Required Training

Preferred:
Motivation Interviewing 

Trauma Informed Care

Physical Requirements

Additional Information