Care Coordinator Specialist II

Job Description

Job Description

Description :

CARE COORDINATOR SPECIALIST II

JOB DESCRIPTION

Reports to : Senior Manager Enhanced Care Management

FLSA Classification : Non-Exempt

Supervises Others : No

JOB SUMMARY : The Care Coordinator Specialist II ensures patient navigation is implemented by managing

client caseloads, conducting intake assessment and reassessment, and advice support Care Coordinators. The

CCS II facilitate conversations between interdisciplinary Care Teams (including Care Coordinators, primary care

physicians, and additional health care providers) and expedite client services referrals. The CCS II provides

support to in the field and supports “high-risk” members and their family / caregiver(s), clinic / hospital / specialty

providers and staff, and community resources in a team approach :

ESSENTIAL DUTIES AND RESPONSIBILITIES :

1. Coordinate with those individuals and / or entities to ensure a seamless experience for the member and

non-duplication of services.

2. Increase continuity of care by managing relationships with tertiary care providers, transitions-in-care, and referrals

3. Screen clients for eligibility for direct and support services and refer clients to needed services, such as

mental health, housing, crisis, and employment assistance

4. Conducts client-specific assessment of needs; identifies problems and establishes client-centered

immediate requirements and long-range goals.

5. Arranges and coordinates a network of supportive services and entitlements (formal and informal)

consistent with mutually-developed care plan.

6. Maintains required records and reports in compliance with department, agency, local, state and federal

requirements.

7. Schedules and attends meetings to provide program information

8. Represents the program with staff and clients and in networking meetings, speakers’ bureaus, and trainings.

9. Accompany member to office visits, as needed and according to the Plan guidelines.

10. Assumes responsibility for all case records and monthly statistics.

11. Responsible for meeting program targets

12. Responsible for meeting departmental goals and key metrics as approved by Senior Management.

13. Attends and participates in all mandatory training sessions and meetings (including CPR and First Aid

training) as prescribed by state regulations.

14. Completes Home Visits, Hospital, and meet with the patient where they are at

15. Develop and coordinate monthly schedules for transportation needs of residents with the transportation

provider, Supportive Services team, and residents.

16. Administer Transportation registration including maintaining registration list, attendance records,

documentation for compliance and provide the information to appropriate partners.

17. Accompany residents on scheduled trips to ensure the safety and well-being of resident participants.

18. Coordinate with hospital, SNF staff on discharge plans

19. Connect member to other social services and supports the member may need, including transportation.

20. Other duties and special projects as assigned.

Requirements :

EDUCATION, EXPERIENCE AND QUALIFICATIONS :

• ? MUST HAVE Bachelor’s Degree in Social Work or Social Services, Gerontology, or Health Sciences.
• ? Licensed Vocational Nurse (LVN) a plus.
• ? Bilingual in Spanish or threshold language.
• ? Prior experience with Care Transitions Program and Methodology
• ? Minimum of 2 years experienced case management, enhanced case management, Care transitions
• ? Minimum of 2 years experienced working with older adults, elderly and people with disabilities.
• ? Experience providing administrative support, report development, and development and dissemination of

materials and tools for new program development preferred.

resources, informal support sources, and other employees; connect client to appropriate resources.

PHYSICAL JOB REQUIREMENTS :