Personal Care Coordinator Sr. (Special Populations) (Bilingual)

Department(s): Case Management
Reports to: Supervisor, Case Management
FLSA status: Non-Exempt
Salary Grade:  D - $21.15 - 32.51 ($44,000 - $67,628)

About CalOptima Health

CalOptima is the single largest health plan in Orange County, serving 880,000 members, or one in four residents. Our motto - "Better. Together." - is at the heart of our mission to serve members with excellence, dignity and respect. We are a public agency made up of compassionate leaders and professionals working together to strengthen our community's health. If you're looking for an opportunity to work for an organization dedicated to improving local health care and serving the needs of the most vulnerable, we encourage you to join CalOptima.

About the Position

The Personal Care Coordinator Sr (Special Populations) will perform a wide variety of advanced support activities for plan members and support CalOptima Health's most vulnerable members such as those experiencing homelessness. The incumbent will ensure regular communication of the member's annual health needs assessment (HNA) or health risk assessment (HRA) and care plan with the member, primary care provider (PCP) and health care team. The incumbent will regularly assess the quality of service given to the member's care by identifying barriers and assisting in improving these barriers via telephone and face-to-face interactions. The incumbent will maintain strong working relationships with the PCP and health care team to ensure member access to timely services and coordination of care.

Duties and Responsibilities: 

• Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.
• Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department.
• Maintains strong working relationships when collaborating with the PCP and health care team to ensure timely communication of member's clinical information and ensures appropriate documentation of all interventions. Also, notifies member's care team of key event triggers.
• Assesses member needs using standardized HNA or HRA requests with members.
• Collaborates with licensed professionals in development of an initial care plan for each member, incorporating the HNA or HRA assessment findings. Facilitates communication of initial care plan to the PCP and member, as necessary.
• Provides outreach and education to members in off-site locations including shelters, community-based organizations and assigned events.
• Facilitates referrals to behavioral health/substance use disorder services and identifies and makes referrals to the Long-Term Support Services (LTSS) department, Community Supports services and community resources.
• Coordinates care and services with members, members' family members/representatives and other providers, as appropriate, including community supports, LTSS and in face-to-face meetings at settings outside of CalOptima Health's locations.
• Processes and maintains complex or sensitive documentation of member's case and care plan within CalOptima Health's medical management system.
• Facilitates transfers to member's assigned case manager in accordance with member needs, when appropriate.
• Anticipates longer-term and more unique member needs by providing guidance in understanding and accessing the benefits they are entitled to under Medi-Cal.
• Maintains compliance with established departmental productivity guidelines; compiles and conducts basic analyses and reporting of productivity metrics to management as required.
• Coordinates and maintains cases in current case load in accordance with case management standards.
• Assists with collection of health risk or health needs assessments as well as gathers medical records as needed.
• Provides regular outreach to assigned members along with members on call lists and evaluates quality of service given to members according to department contact standards.
• Serves as the main point of contact for assigned members in order to anticipate longer term member needs.
• Works with CalOptima Health's staff to expedite the resolution of member concerns.
• Ensures reporting of productivity metrics to the supervisor.
• Completes other projects and duties as assigned. 

Experience & Education: 

• High School diploma or equivalent required.
• 2 years of experience working with the needs of members, such as but not limited to pediatric members, seniors or persons with disabilities (SPD) and/or Special Populations (e.g., homeless or at risk of homelessness) in a customer/member service capacity required.
• Valid driver's license and vehicle or other approved means of transportation, an acceptable driving record and current auto insurance will be required for work away from the primary office 20% of the time or more.
• Bilingual in English and one of CalOptima Health's defined threshold languages (Arabic, Chinese, Farsi, Korean, Spanish, Vietnamese) required.
• An equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above is also qualifying.

Preferred Qualifications:

• Bachelor's degree in Healthcare Management, Social Work, Human Services or related field.
• 2 years of experience with health maintenance organizations (HMO), Medi-Cal and health services.
• Experience working with individuals with behavior health conditions or substance use disorders.

Physical Demands and Work Environment:

The physical demands and work environment characteristics described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. 

• Physical demands: While performing duties of job, employee may need to move about the organization. Employee must be able to sit for extended periods of time, as well as work at the computer for long periods. Employee is required to use hands and fingers, especially for typing on the computer and using the mouse. Employee must be able to communicate with members and other staff, particularly for regular phone use and face-to-face interaction. 

• Work environment: Employee will have one-on-one contact with CalOptima Health's members in various settings and other employees in a quiet environment where hearing and listening is paramount. Typical office environment with moderate noise levels and controlled office temperatures. 

About our Benefits & Wellness options: 

At CalOptima Health, we know that a healthy and happy workforce is a thriving workforce, which is why we offer a comprehensive benefits package, including participation in the California Public Employees Retirement System (CalPERS), low-cost medical/vision/dental insurance options, and paid time off. To support quality work-life balance, we allow flexible scheduling during core business hours, telework options for some positions, work schedules that allow every other Friday off (9/80 schedule), and a wellness program featuring diverse activities. Additionally, CalOptima Health contributes 4% of pensionable earnings to a 401(a) retirement program with no required employee contribution. Employees also have access to 457(b) retirement plans with pre/post-tax contribution options.

CalOptima is an equal employment opportunity employer and makes all employment decisions on the basis of merit. CalOptima wants to have qualified employees in every job position. CalOptima prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics. 

If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability.