Please Note: HPSM does not typically offer relocation assistance. We are only hiring candidates who currently reside in California.
General Description
The Care Management Specialist III coordinates with a multidisciplinary team care to provide person-centered interventions to health plan members, through effective partnerships with their caregivers/families, community resources, and their physician. He or she facilitates shared decision-making within and across settings to achieve coordinated high-quality care that is collaborative and timely.
Qualifications
The following represents the typical way to achieve the necessary skills, knowledge and ability to qualify for this position:
Education and Experience
- Associate’s degree; Bachelor’s degree preferred.
- Three (3) years of managed care experience preferably in Care Coordination or Care Transitions.
- Experience working with the health needs of the population served.
- Experience as a Medical assistant or Licensed Vocational Nurse is a plus.
- Experience with performing interventions with complex populations.
Knowledge
- Personal computers and proficiency in Microsoft Office Suite applications, including Outlook, Word, Excel, Access, and PowerPoint.
- Care management, Medi-Cal, and Medicare benefits as well as the complexities of working with the elderly and disabled population.
- Comprehensive knowledge of Care Transitions.
- Comprehensive knowledge of plan programs, community partners and resources.
Abilities
- Adapt to changes in requirements/priorities for daily and specialized tasks.
- Work autonomously and be directly accountable for practice of case management.
- Work collaboratively with others.
- Work in partnership with a team and support team decisions.
- Utilize member-centric approach to care coordination and care transition.
- Function effectively in a fluid, dynamic, and rapidly changing environment
- Work effectively with people in varying positions and diverse backgrounds, by maintaining cultural competency knowledge and practice.
- Influence and gain consensus on individual and group decision-making.
Skills
- Demonstrate member, provider and interdisciplinary team focused interpersonal skills.
- Communicate effectively through written, verbal and listening communication skills.
- Demonstrate member, provider and interdisciplinary team focused interpersonal skills.
- Conflict resolution, assertiveness, and collaboration skills.
- Bilingual skills highly preferred, particularly Spanish, Tagalog or Chinese.
Licensure/Certifications
Driving
DUTIES & RESPONSIBILITIES
Essential Functions
- Function as part of a multidisciplinary care team to manage plan members utilizing a population
- health management focus.
- Independently handle requests for care coordination, assessing the request, the member’s needs, and facilitating appropriate interventions and follow up.
- Administer Health Risk Assessment and other appropriate assessment tools to members as needed.
- Prepare care plans for members for presentation at interdisciplinary team meetings.
- Assist members with appointments for specialists, educational classes, transportation, community services, and other supports.
- Work with healthcare providers to coordinate and share plans of treatment.
- Collaborate with health and medical care team, community partners and other services providers.
- Support Clinical Care Managers to coordinate members’ appointments, equipment, social services, and home health needs.
- Actively participate in team meetings.
- Maintains required and complete documentation for all activities in the plan’s case management system, MedHOK.
- Facilitate interdisciplinary communication and hand off to other team members
- Provides information and guidance to the member and/or family for an effective care transition, improved self-management skills and enhanced member-provider communication.
- Provide HPSM benefit information and processes with members and care team members.
- Maintain working knowledge of confidentiality practices and standards. Adheres to all standards of confidentiality and patient health information.
- Provide subject matter expertise to other team members and partners on community resources and programs.
- Promotes clear communication amongst the care team, which can include family and community supports, and treating providers by ensuring awareness regarding member care plans.
- Participate in continuous quality improvement efforts.
- Maintain knowledge of HPSM benefit, programs, and processes in order to provide clear information to member and providers.
