Care Coordination Staff

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Attachment A
CARE COORDINATION STAFF
Team Manager/Case Management: Oversees Care Coordination Department. Develops procedures and
protocols relevant to the flow of case management responsibilities. Liaison to disease management
contracted companies Lifemasters and Renaissance. Responsible for review of cases for consideration for
Special Case Managed Member Status and case management of Transplant cases.
Grievance Clinical Lead: (.5) Initiates and coordinates a multidisciplinary team approach to case
management for the handling of grievances with members and/or providers to evaluate, monitor and
assure that medically necessary services are provided in a quality efficient and timely manner.
Health Services Case Manager: (2.5) Liaison to California Children’s Services (CCS), Regional Centers
and Genetically Handicapped Persons Program (GHPP). Administers the EPSDT SS Program for
members under 21 years that require expanded benefits, i.e. 24/7 nursing. Responsible for supporting
members with complex health needs in obtaining care and in meeting treatment goals.
Intensive Care Manager: (1.0) Responsible for the clinical coordination functions of the Complex Case
Managed Population.
Health Care Guide: (1.0) Interviews members to identify those with modifiable risk factors to participate
in the Complex Case Management Program. Under the direction of the Intensive Care Manager assists
members with coordination of services.
Behavioral Health Coordinator: (1.0) Responsible for the Behavioral Health Coordinator for the Complex
Case Managed. Provides coaching and training to members and providers across all product lines
including the PHC staff as all internal customers.
Perinatal Program Coordinator: Coordinates and administers the PHC perinatal care coordination program
and implements strategies to improve high risk perinatal outcomes.
Special Program Assistant: (2) Bilingual coordinators that facilitate an incentive program for pregnant
women to enter care early, remain in care with the right providers and seek timely post partum care.
Initiation of health care for the newborn including lactation consulting, coordination of care and
assistance with obtaining eligibility with a variety of state insurance plans.
Care Coordination Program Assistant: Administrative office support to the team manager and program
staff. Calendar management. Provides bilingual triage of member and provider calls to the appropriate
care coordination staff. Responds to member inquiries regarding the incentive program for the Growing
Together Program (GTPP).
Special Programs Data Coordinator: Manages all data exchange between CCS, GHPP and Kaiser AIDS
Program. Works directly with the CCS Liaison and provides other duties as assigned to support the
Utilization Management of the children with special health care needs. Coordinates CCS meetings to
include agenda development and minutes. Is the primary back up to the Care Coordination Assistant.
Health Coordinator: Welcomes and assesses new Partnership Advantage member’s health risk status
through the use of the approved Health Risk Assessment (HRA) tool. In coordination with the member
and the practitioner, develops a plan that will assist members to navigate their health care network.
Document1Created on 9/28/2015 7:47 PM
Attachment A
Health Coordinator Assistant: Provides general office support to the Health Coordinator and the Special
Programs staff.
Health Educator: Implementation of health education activities that are coordinated and integrated into
the PHC’s continuous quality improvement process. Responsible for the development of PHC’s Health
Education Work plan for the State. Works collaboratively with the other statewide health educators.
Participates in the Cultural and Linguistics work plan. Represents PHC Health Care Disparities Diversity
Workgroup. Authors articles for member news, provider news and community newspapers/magazines.
Document1Created on 9/28/2015 7:47 PM
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