Care Management Specialist III

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

Position overview

• 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 support.
• Work with healthcare providers to coordinate and share plans of treatment.
• Collaborate with health and medical care teams, 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 support, and treating providers by ensuring awareness regarding member care plans.
• Participate in continuous quality improvement efforts.
• Maintain knowledge of HPSM benefits, programs, and processes to provide clear information to members and providers.
• Maintain a caseload of members with complex medical and psychosocial needs.

Requirements

These are the qualifications typically needed to succeed in this position. However, you don’t need to meet every requirement to apply. 

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 of:

• 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.

Ability to:

• Comprehensive knowledge of Care Transitions.
• 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.

Salary and benefits

The starting salary range is $33.32-$42.80 per hour, depending on the candidate’s work experience.

Excellent benefits package includes:

• HPSM-paid premiums for employee’s medical, dental and vision coverage (employee pays 10% of each dependent’s premiums)
• Fully paid life, AD&D and LTD insurance
• Retirement plan (HPSM contributes equivalent of 10% of annual compensation)
• 12 paid holidays a year, 12 paid sick days a year and paid vacation starting at 16 days a year
• Tuition reimbursement plan
• Employee wellness program

It is HPSM's policy to provide equal employment opportunity for all applicants and employees.  HPSM does not unlawfully discriminate based on race, religion, color, national origin, ancestry, physical disability, mental disability, medical condition, marital status, sex, age, sexual orientation, veteran status, registered domestic partner status, genetic information, gender, gender identity, gender expression, or any other characteristic protected by applicable federal, state, or local law.  HPSM also prohibits discrimination based on the perception that an applicant or employee has any of those characteristics or is associated with a person who has or is perceived to have any of those characteristics.