Care Management Specialist II

General Description

The Care Management Specialist II coordinates with a multidisciplinary team care to provide person- centered interventions to health plan members, through effective partnerships with their caregivers/families, community resources, and their physician. They facilitate shared decision- making within and across settings to achieve coordinated high-quality care that is collaborative and timely.

Duties & Responsibilities

Essential Functions:

• Independently handle requests for care coordination, assessing the member’s needs, and facilitating appropriate interventions and follow-ups.
• Administer Health Risk Assessment survey to members as needed.
• Prepare care plans for members for presentation at interdisciplinary team meetings.
• Assist members with appointments for specialists, educational classes, and transportation.
• Work with healthcare providers to coordinate and share plans of treatment.
• Perform data entry of medical information; maintain census tracking and reports.
• Assist Care Coordination Case Managers and staff to coordinate members’ appointments, equipment, social services, and home health needs.
• Actively participate in team meetings.

Secondary Functions:

• Perform other duties as assigned.

Qualifications

The following represents the typical way to achieve the necessary skills, knowledge, and ability to qualify for this position:

Education and experience equivalent to:

• High school diploma or GED required.
• College level courses in health care, a plus.
• Three (3) years of managed care experience, preferably in Care Coordination.
• Experience working with the health needs of the population served.
• Experience as a Medical assistant or Licensed Vocational Nurse is a plus.
• At least one year of direct Care Coordination experience.

Knowledge of:

• Personal computers and proficiency in Microsoft Office Suite applications, including Outlook, Word, Excel, Access, and PowerPoint.
• Care management, Medi-Cal, and Medicare benefits as well as the complexities of working with the elderly and disabled population.
• Community resources.

Abilities to:

• Work cooperatively with others.
• Work as part of a team and support team decisions.
• Communicate effectively, both verbally and in writing.
• Adapt to changes in requirements/priorities for daily and specialized tasks.
• Work cooperatively with others.
• Work as part of a team and support team decisions.
• Communicate effectively, both verbally and in writing.
• Adapt to changes in requirements/priorities for daily and specialized tasks.

Other:

• Bilingual skills highly preferred, particularly Spanish, Tagalog, or Chinese.