SUMMARY: Responsible for delivering comprehensive care management services and providing community-based care coordination to address service gaps experienced by Medi-Cal recipients, meeting Central Coast Alliance for Health (CCAH) outcome expectations. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential job functions.
ESSENTIAL DUTIES AND RESPONSIBILITIES Must be able to perform each essential job function satisfactorily.
Direct Care and Case Management
- In a culturally competent manner will provide services to all participants without regard to race, color, creed, national origin, marital status, sexual orientation, age, sex, religion, and handicap or payment status.
- Conduct and document outreach efforts to engage and enroll eligible participants.
- Conduct assessments of individuals referred to the ECM program to identify medical, behavioral health, and social needs.
- Assess client needs, provide education on self-management techniques, and address barriers to care.
- Monitor and track the progress of participants in achieving their care plan goals, providing ongoing support and guidance as needed.
- Inform participants of their personal rights, responsibilities, and Company’s grievance procedures. Ensure that services are compatible with participants’ freedom of choice.
- Collaborate with interdisciplinary team members to coordinate care and optimize outcomes.
- Adhere to ethical and professional standards of practice, including maintaining client confidentiality and respecting cultural diversity.
- Provide information on health and mental health care issues including prevention, early detection and remedial care to participants, families, other agencies and the community.
- Provide provisions for the safety and guidance of participants with physical challenges.
- As needed transport participants to appointments, outings etc.
Teamwork and Collaboration
- Maintain cooperative and professional working relationships and communications.
- Meet program outcome expectation in collaboration with CCAH.
- Participate in regular team meetings and training to coordinate care and optimize outcomes.
- Give input to management on improving the quality of programs and assist in monitoring program effectiveness and participant satisfaction.
Reporting and Documentation
- Mandated to report any “suspected abuse of dependent adults and elders” directly to Law Enforcement, Adult Protective Services, Ombudsman, or Community Care Licensing.
- Keep clear, accurate, and professional records.
- Meet caseload expectations and work collaboratively to meet program requirements.
- Submit timely and accurate invoices, billing data, and other requested reports.