Reports to: Director Enhanced Care Management, Manager, Enhanced Care Management and/or Quality
Assurance Manager
FLSA Classification: Non-Exempt
Supervises Others: No
Schedule: Mon - Fri 8am-4:30pm
JOB SUMMARY: The Care Coordinator ensures patient navigation is implemented by managing client
caseloads, conducting intake assessment and reassessment. The Care Coordinator is responsible for
performing duties for the Care Coordination program to include: Supportive Housing Programs, Enhanced
Care Management, Care Transitions Service as well as promoting the company services.
Note: Special roles and responsibilities may be applicable to Contract / regulatory program requirements.
ESSENTIAL DUTIES AND RESPONSIBILITIES:
1. Coordinate with those individuals and/or entities to ensure a seamless experience for the member and
non-duplication of services.
2. Increase continuity of care by managing relationships with tertiary care providers, transition-in-care,
and referrals
3. Screen members for eligibility for direct and support services and refer members to needed services,
such as mental health, housing, Medically Tailored Meals, ECM, and MoWOC programs
4. Conducts member assessment; identifies problems and establishes client-centered immediate
requirements and long-range goals. (Contract/ Program Requirement)
5. Arranges and coordinates a network of supportive services and entitlements (formal and informal)
consistent with a mutually developed care plan.
6. Maintains required records and reports in compliance with department, agency, local, state and federal
requirements.
7. Assumes responsibility for all case records and monthly statistics.
8. Responsible for meeting program targets
9. Attends and participates in all mandatory training sessions and meetings (including CPR and First Aid
training) as prescribed by state regulations.
10. Completes home visits, hospital and skilled nursing facility visits (Contract/ Program Requirement)
11. Coordinate with hospital, SNF staff on discharge plans (Contract/ Program Requirement)
12. Develop and coordinate monthly schedules for transportation needs of residents with the
transportation provider, Supportive Services team, and residents.
13. Other duties and special projects as assigned.
EDUCATION, EXPERIENCE AND QUALIFICATIONS:
• Medical assistant certification preferred and or related educational certification
• Case management experienced preferred
• Experienced working with older adults, elderly and people with disabilities.
• 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.
• Working knowledge of programs and services available in Orange County for seniors.
• Proficient in Microsoft Office Suite (Word, Excel, Outlook).
• Strong understanding of cultural competency with the target population
• 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.