Care Management Community Coordinator, Medicare

Reporting to Clinical Supervisor, Care Management, Medicare, the Care Management Community Coordinator, Medicare is a vital member of the Dual Eligible Special Needs Plan (D-SNP) Care Management team, responsible for supporting members, families, and caregivers through a wide range of care coordination activities.

Core responsibilities include telephonic outreach to engage members and complete initial and annual Health Risk Assessments, contributing to and updating individualized care plans, and facilitating communication across the interdisciplinary care team (ICT). The role also involves scheduling ICT meetings when needed, connecting members with appropriate services, tracking and following up on referrals, conducting in-home or community visits as appropriate, and performing essential administrative tasks that help ensure members receive timely, coordinated care. Community Coordinators are trusted, knowledgeable frontline health personnel who typically come from the communities they serve.

The Community Coordinator works closely with medical and behavioral health providers, primary care teams, care coordinators, county partners, and other agencies to improve member care and outcomes.

Please note that while SFHP supports a hybrid work environment, you are required to be onsite and in-office a minimum of 4 days per month.

Salary: $30.00 - $40.00 per hour

WHAT YOU WILL DO:

• Support the completion of Health Risk Assessments (HRA).
• Coordinate and manage the scheduling of Interdisciplinary Care Team (ICT) meetings. You will conduct telephonic outreach to all relevant participants, ensuring availability, and confirming attendance. Additionally, it includes supporting the preparation and distribution of necessary meeting materials.
• Establish positive, supportive relationships with members; explain the purpose and services of the Care Management program to the member, and the benefits that participation in this program includes.
• Help members access services, including scheduling appointments, obtaining a medical home and post-discharge follow-up.
• Coordinate meet-and-greet meetings as requested by providers and/or SFHP Leadership with the goal of exchanging information about our D-SNP program.
• Assist members with completion of applications for programs for which they may be eligible
• Facilitate communication and coordinate services between the member/family/caregiver, providers and Community-Based Organizations (CBOs).
• Complete outstanding workflow tasks related to job duties.
• Expand knowledge and understanding of community resources, services, and programs.
• Work with the member's interdisciplinary team, giving feedback on individualized care plans.
• Update the interdisciplinary team on observations made while working with members, alerting team members to areas that require intervention.
• Coach and motivate members to be active and engaged participants in their health, overcoming barriers to obtaining needed medical care and social services.
• Maintain appropriate documentation in SFHP's record system.
• Collaborate with other identified staff and/or departments.
• Conduct in home-visits or community visits as appropriate.

WHAT YOU WILL BRING:

• Associates degree in a related field or higher; or equivalent work experience.
• Community Health Worker certification preferred
• At least one year of Field Coordinator, Care Navigation, Community, or Public Health work experience
• Bilingual language skills preferred: Chinese, Spanish, Russian, Vietnamese, Tagalog
• Ability to perform outreach to members in the community

WHAT WE OFFER:

• Health Benefits
  
  
  
  • Medical: You'll have a choice of medical plans, including options from Kaiser and Blue Shield of California, heavily subsidized by SFHP.
  • Dental: You'll have a choice of a basic dental plan or an enhanced dental plan which includes orthodontic coverage.
  • Vision: Employee vision care coverage is available through Vision Service Plan (VSP).
  
  
  
  
• Retirement - Employer-matched CalPERS Pension and 401(a) plans, 457 Plan.
• Time off - 23 days of Paid Time Off (PTO) and 13 paid holidays.
• Professional development: Opportunities for tuition reimbursement, professional license/membership.

ABOUT SFHP:

Established in 1997, San Francisco Health Plan (SFHP) is an award-winning, managed care health plan whose mission is to provide affordable health care coverage to the underserved low and moderate-income residents in San Francisco County. SFHP is chosen by eight out of every ten San Francisco Medi-Cal managed care enrollees and its 175,000+ members have access to a full spectrum of medical services including preventive care, specialty care, hospitalization, prescription drugs, and family planning services.

San Francisco Health Plan is proud to be an equal opportunity employer. We are committed to a work environment that supports, inspires, and respects all individuals and in which our people processes are applied without discrimination on the basis of race, color, religion, sex, sexual orientation, gender identity, marital status, age, disability, national or ethnic origin, military service status, citizenship, or other protected characteristics.

Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.

San Francisco Health Plan is an E-Verify participating employer.

Hiring priority will be given to candidates residing in the San Francisco Bay Area and California.

#LI-Hybrid

(Hybrid remote/in-office)

PI283735019