Health Care Guide 1

Overview

In collaboration with Care Coordination team members, this position provides support andguidance to HealthPlan members referred to the Care Coordination Department for CaseManagement services and programs. The Health Care Guide I works closely with members,families, providers, community agencies, and the interdisciplinary care team to assist incoordination of benefits in a timely and cost-effective manner, while connecting members toavailable internal and external resources.

Responsibilities

Essential Duties and Responsibilities

▪ Acts as the point of contact for members, families, providers, and/or community agenciescalling into the Care Coordination Department requesting assistance and informationabout available Partnership programs and information.▪ With direction, initiates and processes referrals to appropriate programs in accordancewith department policies, and communicates referral outcomes to referral source.▪ Collaborates with members, families, providers, and/or community agencies to identifymember needs and/or barriers.▪ Conducts targeted assessments to identify care coordination needs.▪ Researches appropriate and available Partnership and/or community resources and providesguidance to member and interdisciplinary care team.▪ Creatively utilizes available resources in the most cost-effective manner in collaborationwith the Case Manager.▪ Assists members to ensure timely access to providers and services.▪ Initiates and processes referrals to appropriate programs in accordance with departmentpolicies, and communicates referral outcomes to referral source.▪ Completes timely and accurate documentation in appropriate systems in accordance withdepartment policies.▪ Supports the Care Coordination Department by answering the ACD telephone line,determining call urgency and routing calls appropriately▪ Provides excellent customer service and communicates with others in accordance withPartnership standards and expectations.▪ Exhibits high professional standards as outlined in Partnership’s Code of Conduct▪ Communicates clearly and effectively through all mediums of communication withmembers, providers, vendors, community partners, and Partnership employees.▪ Responds to inquiries in a timely manner.▪ Connects members to community agencies when necessary

Secondary Duties and Responsibilities

▪ Obtains records and information as requested by clinical staff.▪ Provides support and assistance to clinical staff as needed.▪ Collaborates with internal Partnership departments to resolve issues.▪ Attends required meetings and trainings in person when assigned.▪ Provides periodic coverage during vacations or sick time for Health Care Guide staff asneeded within assigned team.▪ Performs other duties as assigned by the direct supervisor, including the assumption ofnew duties.

Qualifications

Education and Experience

High school diploma or equivalent combination of experience andeducation required; associate’s or bachelor’s degree preferred. Two (2)years of experience working in a health care setting recommended, toinclude experience in case management or care coordination; or anywork experience, training or specialized education that would likelyprovide the ability to perform the essential functions of the position.Preference may be given to individuals certified and/or licensed in ahealth related field.

Special Skills, Licenses and Certifications

Ability to use good judgment, take personal initiative, and usediscretion in performing job responsibilities. Attention to detail andaccuracy. Basic knowledge of medical terminology and coding. Abilityto listen actively and practice motivational interviewing. Knowledge ofthe Partnership and basic concepts of managed care. Ability to learn thefollowing: case management role within a health plan setting, and theHealthPlan eligibility categories. Ability to use computer software forword processing, spreadsheets, and email, operating multiple computerprograms simultaneously. Ability to function effectively with frequentinterruptions and direction from multiple team members. Ability towork in an environment with diverse individuals and groups. Ability toestablish collaborative relationships. Ability to work autonomouslywithin a team setting. Ability to prioritize workload and initiate actionto acquire needed information from professionals by phone. Bilingualskills in an approved threshold language is preferred. Valid Californiadriver’s license and proof of current automobile insurance compliantwith Partnership policy are required to operate a vehicle and travel forcompany business.

Performance Based Competencies

Communicates clearly and effectively through all mediums ofcommunication with members, providers, vendors, communitypartners, and Partnership employees. Models appropriate behavior fordepartment. Ability to work effectively with Medi-Cal and otherspecial needs populations. Ability to work with ethnically andculturally diverse populations. Ability to maintain positive, cooperativerelationships with the community, professional groups, public officials,and agencies and represent the department with professionalism.Ability to manage multiple tasks. 

Work Environment And Physical Demands

Standard cubicle workstation with a shared common area. Use oftelephone, fax, computer, and photocopying machine is required.Requires sitting in front of computer equipment and talking ontelephone for major portion of the workday. Must be able to work in afast-paced environment and maintain courtesy and composure whendealing with internal and external customers. When necessary, must be

able to lift, move, or carry objects of varying size, weighing up to 35lbs. Face to face contact with members and some travel potentiallyrequiring over-night stay may be expected.

All HealthPlan employees are expected to:

• Provide the highest possible level of service to clients;
• Promote teamwork and cooperative effort among employees;
• Maintain safe practices; and
• Abide by the HealthPlan’s policies and procedures, as they may from time to time be updated.

HIRING RANGE:

$29.9535 - $35.1954

IMPORTANT DISCLAIMER NOTICE

The job duties, elements, responsibilities, skills, functions, experience, educational factors and the requirements and conditions listed in this job description are representative only and not exhaustive of the tasks that an employee may be required to perform. The employer reserves the right to revise this job description at any time and to require employees to perform other tasks as circumstances or conditions of its business, competitive considerations, or work environment change.