Behavioral Health Personal Care Coordinator

Santa Clara Family Health Plan•San Jose, CA

About The Position

The Behavioral Health Services Personal Care Coordinator is responsible for supporting and coordinating internal and external resources for members referred to case management programs for all lines of business in compliance with all applicable state and federal regulatory requirements, SCFHP policies and procedures, and business requirements.

Requirements

Bachelor's Degree in a health related field or equivalent experience, training or coursework. (R)
Minimum three years of relevant experience in a healthcare or community setting providing care coordination of health and/or social services. (R)
Maintenance of a valid California driver’s license and acceptable driving record, in order to drive to and from offsite meetings or events; or ability to use other means of transportation to attend offsite meetings or events. (R)
Proficient in adapting to changing situations and efficiently alternating focus between telephone and non-telephone tasks to support department operations as dictated by business needs. (R)
Ability to consistently meet accuracy and timeline requirements to maintain regulatory compliance. (R)
Ability to work within an interdisciplinary team structure. (R)
Working knowledge of and the ability to efficiently operate all applicable computer software including computer applications such as Outlook, Word, Excel, and specific case management programs. (R )
Ability to use a keyboard with moderate speed and a high level of accuracy. (R)
Excellent communication skills including the ability to express oneself clearly and concisely when providing service to SCFHP internal departments, members, providers and outside entities over the telephone, in person or in writing. (R)
Ability to think and work effectively under pressure and accurately prioritize and complete tasks within established timeframes. (R)
Ability to assume responsibility and exercise good judgment when making decisions within the scope of the position. (R)
Ability to maintain confidentiality. (R)
Ability to comply with all SCFHP policies and procedures. (R)
Ability to perform the job safely and with respect to others, to property and to individual safety. (R)

Nice To Haves

Knowledge of Medicare and/or Medi-Cal benefits, community resources and principals of case management. (D)
Knowledge of medical terminology. (D)
Knowledge of Santa Clara County Health and Social Services. (D)

Responsibilities

Work with case managers to assist members navigating the healthcare delivery system and home and community-based service to facilitate access related to medical, psychosocial and behavioral health benefits and services.
Monitor and respond to inbound case management inquiries and referrals and escalate to clinical staff, as appropriate.
Provide outreach to members to facilitate timely completion of Health Risk Assessments (HRA’s) by telephone, mail or in person, as needed.
Support the coordination of member care with PCP, Specialists, Behavioral Health and Long Term Services and Supports providers and other stakeholders to assist member to achieve or maintain a level of functional independence which allows them to remain at home or in the community.
Assist with coordinating the involvement of the interdisciplinary care team (ICT) members including the member and/or their family/responsible party to implement the individualized care plan (ICP). Oversee correspondence related to care plans. Document ICT meetings following SCFHP policies and procedures.
Support successful transition of care for members who move between care settings by coordinating services for medical appointments, pharmacy assistance and by facilitating utilization review. Assist to ensure follow up for psychiatric hospitalizations for members to obtain psychiatric/behavioral health care.
Follow UM policies and procedures for new authorization requests. May conduct data entry into the authorization software application system and determination notification to member and/or provider in accordance with regulatory timeframes.
Produce and distribute internal reports that may include QI reports, member admission and discharge reports and external stakeholder reports, as appropriate.
Follow established Health Services policies and procedures and use available resources to respond to member and/or provider inquiries and resolve any concerns in an accurate, timely, respectful, professional and culturally competent manner.
Maintain knowledge of current resources in communities served by our members to support case management goals.
Develop effective and professional working relationships with internal and external stakeholders and partners. Communicate effectively with members and providers orally and in writing.
May support and conduct non-clinical training in accordance with training guidelines and protocols; provide input and develop training and reference materials. May develop Behavioral Health department orientation binder and assist with onboarding of new employees.
Identify issues and trends (data, systems, member, provider, other) as well as general departmental questions/concerns; report relevant information to management; and make recommendations to improve operations.
Collaborate with team members on improvement efforts across-departments regarding quality improvement projects, optimization of utilization management, and member satisfaction.
Attend and actively participate in daily, weekly, and monthly departmental meetings, in-services, training, coaching sessions and external stakeholder meetings.
Understanding of Behavioral Health and 1115 Waiver programs, including Alcohol and Drug Services and assess members for appropriate referrals into these programs. May be required to facilitate Behavioral Health Treatment (BHT) services, including identification of providers, timely access to assessment and treatment.
Perform other duties as required or assigned.