The Health Services and Care Coordinator plays an important and unique role in the MSO Care Coordination and Case Management team. Candidate is required to have well understanding to 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 to facilitate medical, behavioral, social and community support services for patients in need of enhanced care coordination services. These services will be through the development of a multi-disciplinary care plan, self-management goals and referrals to both internal and external resources.
Candidate is also required to have efficient communication skills, able to build effective working relationships with patients and family members, healthcare providers and teams, and community resources providers. Strong communication skills will be used, 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 navigate 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, assist patients with benefit coverage and access to care questions/concerns
- Provide enhanced care coordination services assisting patients in problem solving with 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 services providers for care coordination and case management activities including implementation of Care Plan
- Work with patients both in person and over the phone to review and remind their plan of care and progress towards their care management goals
- Conduct outreach activities to assigned members by phone, mail or any other form of communication method to promote program engagement and NEMS marketing strategy
- 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 and remain in compliance with local, state, and federal regulation
- Performs other job duties as required by manager/supervisor
- Completion of a 2 year degree in Social Work or related field is required
- 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 program
- 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
- Must be able to fluently speak, read and write English.
- Fluent in Chinese (Cantonese and/or Mandarin) required.
- Fluent in other languages are an asset.
- 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).