Primary Function

This position is fast-paced with a high caseload; responsible for completing health assessments in a timely manner, developing and implementing care plans for enrollees, and assisting enrollees in achieving their health goals. This position acts as the care coordinatorworking with an interdisciplinary care team to manage the care and pharmacotherapy of enrollees.

Essential Responsibilities:

  1. Assist with and promote the identification of enrollees with special healthcare needs.
  2. Work as a team with other South Country Health Alliance (SCHA) staff and county staffto meet medical and care coordination needs of enrollees.
  3. Collaborate and share information with interdisciplinary team in order to identify and assist enrollees with benefit or utilization issues through focus reviews and care coordination.
  4. Assess enrollee needs, unmet needs, strengths and assets in order to identify case management strategies that will best assist the enrollee’s condition.
  5. Evaluate individualized care and effectiveness in accordance with standards or protocols for enrollees by developing and carrying out an enrollee-centered care plan.
  6. Help to ensure the enrollee’s health care and care coordination services are comprehensive, community-based, culturally sensitive, enrollee-centered, high quality and cost effective.
  1. Serve as a contact point, advocate and informal resource for enrollees by facilitating their access to providers, interdisciplinary team members and additional resources.
  2. Serve on committees and task forces as appropriate to contribute to program improvements.
  3. Coordinate efforts to gain member feedback regarding their experience of benefits and services; participate in interventions which address enrollee articulated needs.
  4. Other duties assigned within the scope, responsibility and requirements of the job.

Additional Qualifications:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required.

Language Skills:

Must be able to read and write in English. Knowledge of Spanish preferred.

Mathematical Skills:

Analytic skills required.

Accuracy:

Work is not checked; impact of errors or negligence would cause significant loss, waste of time and/or materials or significantly affect enrollee’s ability to access services or relationships with business partners.

Reasoning Ability:

Requires use of considerable judgment and broad decision making, complex problem solving (technically and administratively); Must understand cause and effect relationships and be able to draw conclusions from data, regulatory requirements and past practices.

Physical demands:

The physical demands described represent those that must be met by an employee to successfully perform the essential functions of this job. Where possible, reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is regularly required to talk or hear. The employee frequently is required to sit, stand and drive and; use hands to navigate office equipment (i.e. computer, telephone) and use office supplies; and reach with hands and arms.

The employee may occasionally lift and/or move up to 25 pounds. Specific vision abilities required by this job include close vision, distance vision, peripheral vision, depth perception, and the ability to adjust focus.

The duties of this job require the employee to be seated at a computer approximately 75% of the time. Communication by telephone is an integral part of this position.

Work Environment:

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee should encounter no unusual or hazardous conditions. The noise level in the work environment is usually low.

Travel Requirements:

Must be able to travel in-state to counties within our service area for meetings and trainings an average of 1-2 days per month.

Contacts:

Maintains satisfactory relationships; may include collaboration in executing established policies, discussion of ways to reach agreed-upon objectives, securing compliance with approved procedures.

Financial Impact:

Moderate monetary responsibility and risk.

This position is responsible for ensuring that South Country Health Alliance is following contract language as promulgated by governmental agencies. Failure to comply with this contractual language could result in breach of contract resulting in a moderate financial penalty, potential contract cancellation, sanctions and/or corrective action.

1