As a part of the Tenet and Catholic Health Initiatives family, Conifer Health brings 30 years of healthcare industry expertise to clients in more than 135 local regions nationwide. We help our clients strengthen their financial and clinical performance, serve their communities and succeed at the business of healthcare. Conifer Health helps organizations transition from volume to value-based care, enhance the consumer and patient healthcare experience and improve quality, cost and access to healthcare. Are you ready to be part of our solutions? Welcome to the company that gives you the resources and incentives to redefine healthcare services, with a competitive benefits package and leadership to take your career to the next step!
This position will serve as a liaison between Special Needs Persons (SNP) members, the PMG, Health Plan, medical providers, behavioral health providers and Long Term Support and Service (LTSS) providers. The PMG Personal Care Coordinator (PCC) will identify and reduce barriers to membersâ�� care, assist the member in locating and accessing resources and educate the member on the importance of accessing care promptly. The PMG PCC will serve as the primary point of contact for the member and will be an integral part of the memberâ��s interdisciplinary care team (ICT). The PMG PCC provides support to the member as they self-navigate the health care system. The PMG PCC works closely with memberâ��s case management team to resolve access, medical and psychosocial related issues. This PMG PCC must be able to efficiently manage and prioritize a caseload of 400 members.
Degree of Supervision:
This position reports to the Ambulatory Case Management Supervisor. This position works under the direct supervision of a licensed clinical professional to ensure optimal coordination of care for the OneCare members requires moderate degree of supervision to ensure tasks are appropriately prioritized.
Job Duties and Essential Functions:
Collaborate with Health Plan staff to ensure timely communication of memberâ��s clinical information.
Effectively interview members to determine strengths, problems, functional status, goals and need for specific services/resources.
Remain knowledgeable of SNP benefit structure. Guide members in understanding and accessing the benefits they are entitled to under Medicare and Medi-Cal, through the Health Plan program.
Assist with coordination of memberâ��s health care and social service needs both within and outside the Medical Group and Health Plan.
Develop rapport, establish and maintain effective interpersonal relationships with internal and external contacts at all levels. Coordinate the timely resolution of member and Provider concerns.
Communicate effectively, both verbally and in writing with individuals from varying cultural and ethnic backgrounds.
Facilitate communication of the member Health Risk Assessment (HRA) and initial care plan (ICP) to the primary care physician (PCP).
Coordinate and schedule the Interdisciplinary Care Team (ICT) meeting for the member with the appropriate Team members.
Complete ICT meeting proceeding notes in timely manner. Maintain filing of assigned ICT minutes and forward to Health Plan.
Complete the member annual Plan of Care ensuring member, PCP, PMG, and Health Plan receive document copy.
Notify memberâ��s care team of key event triggers (ie. Transitions of Care, falls, unsafe home)
Outreach to members to complete assessment when there are changes to a memberâ��s health status (ie. key events). Collaborate with PCP and clinicians to document modifications to the ICP as appropriate. Ensure member, PCP, PMG and Health Plan receive copy of updated plan.
Communicate promptly to the Health Plan of memberâ��s case notes, HRA, care plan and interdisciplinary care team (ICT) proceedings for integration into other Health Plan medical management programs.
Assist member in meeting their preventive care goals (ie. HEDIS measures, Evidence Based Outcome Measure activities).
Assist member with scheduling of appointments. Promote, foster and document member barriers and compliance with ICP. Document collaboration with clinicians on strategies, plans and outcomes for overcoming barriers.
Facilitate referrals to LTSS, behavioral health and other community resources in collaboration with clinician and Social Workers,
Initiate referrals to both internal and external care management departments and other department/government or community agencies.
Facilitate warm transfers to memberâ��s assigned case manager or social worker in accordance with member needs, when appropriate.
Maintain accurate records and documentation.
Maintain and keep in total confidence, all files, documents and records that pertain to the operation of business of Conifer Value-Based Care.
Attend all mandatory trainings.
Perform all other job related duties as it relates to the job function or as delegated by the management team.
Conifer requires its candidates, as applicable and as permitted by law, to obtain and provide confirmation of all required vaccinations and screenings prior to the start of employment. This may include, but is not limited to, the COVID-19 vaccination, influenza vaccination, and/or any future required vaccines and screenings.
High School diploma or GED. Medical Assistant preferred. Equivalent clinical work experience considered.
One year Managed care experience (HMO, Medi-Cal/Medicare, Long Term Services and Supports and Community Health services) preferred. Experience in customer service. Preferably with proficient EzCap, Word, Excel computer skills. Excellent written and verbal communication skills. Problem solving and analytical skills. Ability to speak second language is preferred. Knowledgeable in principles and techniques to serve populations in diverse social and ethnic groups.
Light physical effort (lift up to 10lbs). Mostly sedentary work. Regularly needs to be able to bend, stoop and reach to file. Must be able to drive.
Employment practices will not be influenced or affected by an applicantâ��s or employeeâ��s race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other legally protected status. Tenet will make reasonable accommodations for qualified individuals with disabilities unless doing so would result in an undue hardship.
Tenet Healthcare Corporation (NYSE: THC) is a diversified healthcare services company headquartered in Dallas with 112,000 employees. Through an expansive care network that includes United Surgical Partners International, we operate 65 hospitals and approximately 510 other healthcare facilities, including surgical hospitals, ambulatory surgery centers, urgent care and imaging centers and other care sites and clinics. We also operate Conifer Health Solutions, which provides revenue cycle management and value-based care services to hospitals, health systems, physician practices, employers and other clients. Across the Tenet enterprise, we are united by our mission to deliver quality, compassionate care in the communities we serve.