Care Management Coordinator II; ALD

Overview

Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members, we ensure our members get the right care at the right place at the right time. Mission: L.A. Care’s mission is to provide access to quality health care for Los Angeles County’s vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.

The Care Management Coordinator II is responsible for outreach to members/caregivers, providers, Community Based Organizations (CBO), and others to help enroll our highest-need members into the Care Management (CM) and Disease Management (DM) programs. The position assesses member strengths, challenges, needs, and barriers to care through conducting telephonic Health Risk Assessments (HRA). It works with the member/caregiver, Care Management Specialist, Community Health Worker, and the Interdisciplinary Care Team (ICT) to support the development and implementation of the care plan and address unmet needs.

This position coordinates the flow of information between the CM team and the member/caregiver, provider, medical group, and other ICT members. It supports coordination of member care as instructed by the Care Management Specialist and outlined in the care plan, including reinforcement of health education and disease management information; coordinating benefits such as transportation and DME; and linking the member to community resources to address the Social Determinants of Health (SDoH).

The position ensures the CM team meets contractual and regulatory requirements and timelines by maintaining accurate documentation and following up with the member and provider as needed. The position may be assigned projects to support the department in meeting regulatory and contractual requirements, such as running reports, data validation, quality checks and other projects. The position assists with communication and coordination between programs and maintains confidentiality when communicating member information.

• Responsible for time-sensitive processes for initiating cases, managing referrals to the department, appropriate documentation, routing of information, data entry, faxing, emailing, filing of confidential member information, and maintaining logs of activity. (40%)
• Engages members to participate in the CM/DM programs by reaching out and promoting the programs to address unmet needs. (10%)
• Completes telephonic calls to conduct the HRA with high-risk members in the CM program. Assists the care team with developing and assessing health interventions. (10%)
• Conducts telephonic outreach calls to members/caregivers regularly and evaluates and documents progress toward healthcare goals. Collaborates with the Care Management Specialist to set up provider/specialist appointments and follow up on treatment plans. (10%)
• Handles incoming and outgoing calls to members/caregivers and providers to coordinate care as identified in the care plan. (10%)
• Initiates follow-up calls to members to administer screenings or confirm linkage to appropriate resources. Provides general information to members and providers about the CM and DM programs. (10%)
• Performs other duties as assigned. (10%)

Education Required: High School Diploma or High School Equivalency Certificate

Education Preferred: Associate’s Degree

Experience

Required: At least 6 months of experience in an administrative and customer service role in a health care/health services setting.

Preferred: 1 year of Medical Assistant experience; 6 months of experience processing authorizations at a managed care/health plan setting.

Required: Knowledge of medical terminology; strong verbal and written communication skills; proficiency in Microsoft Office with a high level of accuracy; excellent organizational and time management skills; detail-oriented and a team player; excellent customer service skills with compassion and empathy; ability to…