Care Coordinator Specialist II

CARE COORDINATOR SPECIALIST II

Reports to: Senior Manager Enhanced Care Management FLSA Classification: Non‑Exempt Supervises Others: No Job Summary The Care Coordinator Specialist II ensures patient navigation is implemented by managing client caseloads, conducting intake assessment and reassessment, and providing support to Care Coordinators. The CCS II facilitates conversations between interdisciplinary Care Teams (including Care Coordinators, primary care physicians, and additional health care providers) and expedites client services referrals. The CCS II provides support in the field and supports "high-risk" members and their family/caregivers, clinic/hospital/specialty providers and staff, and community resources in a team approach. Essential Duties and Responsibilities Coordinate with those individuals and/or entities to ensure a seamless experience for the member and non‑duplication of services. Increase continuity of care by managing relationships with tertiary care providers, transitions‑in‑care, and referrals. Screen clients for eligibility for direct and support services and refer clients to needed services, such as mental health, housing, crisis, and employment assistance. Conduct client‑specific assessment of needs; identify problems and establish client‑centered immediate requirements and long‑range goals. Arrange and coordinate a network of supportive services and entitlements (formal and informal) consistent with a mutually‑developed care plan. Maintain required records and reports in compliance with department, agency, local, state, and federal requirements. Schedule and attend meetings to provide program information. Represent the program with staff and clients and in networking meetings, speakers’ bureaus, and trainings. Accompany member to office visits, as needed and according to the Plan guidelines. Assume responsibility for all case records and monthly statistics. Responsible for meeting program targets. Responsible for meeting departmental goals and key metrics as approved by Senior Management. Attend and participate in all mandatory training sessions and meetings (including CPR and First Aid training) as prescribed by state regulations. Complete home visits, hospital visits, and meet with the patient where they are at. Develop and coordinate monthly schedules for transportation needs of residents with the transportation provider, Supportive Services team, and residents. Administer transportation registration, including maintaining registration list, attendance records, documentation for compliance, and provide the information to appropriate partners. Accompany residents on scheduled trips to ensure the safety and well‑being of resident participants. Coordinate with hospital, SNF staff on discharge plans. Connect member to other social services and supports the member may need, including transportation. Other duties and special projects as assigned. Education, Experience and Qualifications MUST HAVE Bachelor’s Degree in Social Work or Social Services, Gerontology, or Health Sciences. Licensed Vocational Nurse (LVN) is a plus. Bilingual in Spanish or threshold language. Prior experience with Care Transitions Program and Methodology. Minimum of 2 years experience in case management, enhanced case management, Care transitions. Minimum of 2 years experience working with older adults, elderly, and people with disabilities. Experience providing administrative support, report development, and development and dissemination of materials and tools for new program development preferred. Excellent communication, written, and interpersonal skills. Thorough knowledge of case management principles and techniques. Maintains professional and confidential standards in client business‑related activities. Demonstrates a "can-do" spirit, a sense of optimism, and commitment. Good problem‑solving skills and critical thinking skills required. Ability to identify client/patient and family needs; develop cooperative working relations with community resources, informal support sources, and other employees; connect client to appropriate resources. Working knowledge of programs and services available in Orange County for seniors. Proficient in Microsoft Office Suite (Word, Excel, Outlook). Must pass background check. Physical Job Requirements Frequently remains in a stationary position and traverses locations. Frequently operates equipment, computers, or tools. Frequently extends body, arms or hands as needed to perform essential duties and responsibilities. Occasionally ascends/descends as needed to complete essential duties and responsibilities. Constantly speaks, communicates, interprets or exchanges information accurately. Constantly perceives objects over moderate or long distances, with or without accommodation. Occasionally distinguishes differences or similarities in intensity or quality of odors. Occasionally moves, transports, and positions objects weighing up to 50 pounds. #J-18808-Ljbffr FSO SKILLED PERSONNEL