Care Management Specialist III at Health Plan of San Mateo

, California, United States -

Full Time

Start Date

Immediate

Expiry Date

02 Jan, 26

Salary

0.0

Posted On

04 Oct, 25

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Care Coordination, Care Transitions, Interpersonal Skills, Communication Skills, Conflict Resolution, Cultural Competency, Microsoft Office Suite, Health Risk Assessment, Care Management, Medi-Cal, Medicare, Team Collaboration, Documentation, Community Resources, Self-Management Skills, Bilingual Skills, Quality Improvement

Industry

Hospitals and Health Care

Description

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 Not Applicable. Driving Not Applicable. 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.

Responsibilities

The Care Management Specialist III coordinates care for health plan members through partnerships with caregivers, community resources, and physicians. They facilitate shared decision-making and ensure high-quality, timely care through effective communication and collaboration.