Personal Care Coordinator (Whole Child Model), Orange, California

Personal Care Coordinator (Whole Child Model)

Job Description
Department(s): Case Management
Reports to: Supervisor Case Management
FLSA status: Non-Exempt
Salary Grade: C - $43,281 - $61,798



Applications will be accepted on a continuous basis until a sufficient number of qualified applications have been received. The deadline for the first review of applications is on Friday , December 1, 2023 at 11:59 PM. Applicants are encouraged to apply early. Applicants that apply after the first review are not guaranteed to be considered for this recruitment. This recruitment may close at any time without notice after the first review date.

About CalOptima Health

CalOptima Health 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 Health.

About the Position

The Personal Care Coordinator (Whole Child Model) will support members and families of children with special health care needs in the completion of a Health Needs Assessment (HNA). The incumbent will ensure communication of the member's HNA and care plan with the member, health network and health care team. The incumbent will identify barriers to members' care and develop and make recommendations for comprehensive care plans at all levels of care. Additionally, the incumbent will support Annual Medical Review (AMR) needs and Inter-County Transfers (ICT) for Whole Child Model (WCM) members. The incumbent will also support member referrals to Orange County Health Care Agency for California Children Services (CCS) eligible conditions. The incumbent will work with the health networks to ensure member access to timely services, coordination of care and timely submission of necessary clinical information. The incumbent will work with the members, family and other members of the health care team to implement a member-centered care plan.



Duties & 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.
• Manages a panel of members independently, assists members with health care access and proactively works with them to achieve their health care goals.
• Collaborates with health networks to ensure timely communication of members' clinical information.
• Works with Case Management staff, CCS and other members of the health care team to facilitate medical care and expedite the resolution of member concerns.
• Performs outreach to members to coordinate the completion of the initial and annual HNA.
• Facilitates communication of initial care plan to the primary care provider (PCP), health network and member, as needed.
• Maintains documentation of the member's case, care plan and interdisciplinary care team within CalOptima Health's medical management system.
• Facilitates referrals to behavioral health services.
• Identifies member needs and assists members with referrals to community resources to meet those needs.
• Guides members in understanding and accessing the benefits they are entitled to under Medi-Cal and CCS.
• Notifies the members' care team of key event triggers.
• Completes other projects and duties as assigned.

Experience & Education:

• High School diploma or equivalent required.
• 1 year of experience working with the needs of pediatric members in a member service capacity 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 Health Care Management, Social Work, Human Services or related field.
• Health Maintenance Organization (HMO), Medi-Cal and Pediatric Health services experience.
• Bilingual in English and one of CalOptima Health's defined threshold languages (Arabic, Chinese, Farsi, Korean, Spanish, Vietnamese).

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 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. Must also be able to reach with hands and arms and must occasionally lift office supply boxes or laptop case, up to 25 pounds. Employee must be able to communicate, particularly for regular phone use, in meetings, face-to-face interaction and while presenting.

• Work environment: 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 Health is committed to attracting, hiring, and retaining a diverse staff, where we will honor your unique experiences, identity, and perspectives. Our organization strives to create and maintain a workplace environment that is inclusive, equitable and welcoming so we can truly be Better Together.



CalOptima Health is an equal employment opportunity employer and makes all employment decisions on the basis of merit. CalOptima Health wants to have qualified employees in every job position. CalOptima Health 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 Health 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.


Job Location: Orange, California
Position Type:

To apply, visit https://jobs.silkroad.com/CalOptima/Careers/jobs/4446








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