Job Details Job Location : Burlingame, CA Salary Range : $39.50
SUMMARY OF POSITION:
The Health Services and Care Coordinator plays an important and unique role in the MSO Care Coordination and Case Management team. The candidate is required to have a well understanding of the many benefits and coverage offered by the different managed care products, including Medicare Advantage, D-SNP, Medi-Cal Managed Care, and other Supplemental programs. In order to ensure eligible patients are receiving timely and efficient health care and support services, the HSCC will be responsible for facilitating medical, behavioral, social, and community support services for patients in need of enhanced care coordination services. These services will be provided through the development of a multi-disciplinary care plan, self-management goals, and referrals to both internal and external resources.
The HSCC is also required to have efficient communication skills to build effective working relationships with patients and family members, healthcare providers and teams, and community resources providers. This role aims to improve coordination of patient care, reduce and remove cultural and healthcare system barriers, promote timely treatment, empower and coach patients to become self-advocates, and assist patients in navigating the maze of the managed care delivery system.
ESSENTIAL JOB FUNCTIONS:
Be the system navigator and point of contact for patients enrolled in managed care programs, assisting patients with benefit coverage and access to care questions/concerns.
Provide enhanced care coordination services, assisting patients in problem-solving issues related to the health care system, financial, or social barriers (e.g., request medical interpreter or transportation as appropriate, prescription drugs formulary assistance, etc.).
Track and support patients when they obtain services outside of NEMS, e.g., Emergency Departments, Hospitals, and other health care offices and facilities. Provide immediate care coordination services after ED and hospital discharges.
Identify and link patients with cultural and community resources to facilitate referrals and respond to social services needs.
Provide relevant self-management support for patients with chronic illnesses as identified by the clinical teams.
Establish and maintain relationships with identified service providers. Assist the NEMS care team with developing and assessing health interventions.
Collaborate with other service providers for care coordination and case management activities, including the implementation of Care Plans.
Work with patients both in person and over the phone to develop and review their plan of care and progress towards their care management goals.
Conduct outreach activities to assigned members by phone, mail, or any other forms of communication to promote program engagement and NEMS marketing strategy.
Operate company vehicle for in-person engagements.
Provide virtual interpretation to non-English speaking patients for medical appointments (upon Interpreter certification).
Assist in data collection and report statistical information to MSO leadership.
Participate in Performance Improvement/Continuous Quality Improvement activities and attend conferences and meetings as needed.
Ensure compliance with local, state, and federal regulations.
Perform other job duties as required by manager/supervisor.
QUALIFICATIONS:
Completion of a 2-year degree in general education preferred, may be substituted with one year of relevant work experience in a healthcare setting.
Valid driver’s license and ability to operate a company vehicle.
Prior experience with customer services.
Strong English verbal and written communication skills with strong analytical and problem-solving skills.
Ability to take and follow through with delegated tasks and accountability.
Working knowledge of project management and outreach programs.
Knowledge of State/Federal healthcare compliance requirements, particularly DHCS/Medi-Cal guidelines a plus.
Ability to self-manage in a detail-oriented environment.
Ability to operate PC-based software programs or automated database management systems.
Good organization and prioritization skills, outstanding in time management.
LANGUAGE:
Must be able to fluently speak, read, and write English.
Fluency in Chinese (Cantonese and/or Mandarin), Vietnamese, or Spanish required.
Fluency in other languages is an asset.
STATUS:
This is an FLSA Non-exempt position.
This is not an OSHA high-risk position.
NEMS is proud to be an Equal Opportunity Employer welcoming diversity in our workforce. Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.
NEMS BENEFITS: Competitive benefits, including free medical, dental, and vision insurance for employee, spouse, and/or children; and company contribution to 401(k).