Shasta Community Care Coordinator - 2025

Ministerial Association of Colusa County; California; On-site; USD 40,000 - 80,000; Full time

Job summary

An established industry player is seeking a Community Care Coordinator to enhance the lives of vulnerable populations. This role involves engaging with members to provide tailored care management and support services, ensuring they receive the resources they need. You'll collaborate with healthcare professionals and community partners to create effective care plans and advocate for members' needs. If you have a passion for community service and possess strong interpersonal skills, this opportunity allows you to make a significant impact while working in a supportive environment dedicated to uplifting those in need.

Qualifications

• 2+ years of case management or related experience required.
• Bilingual in English/Spanish preferred for effective communication.

Responsibilities

• Coordinate Enhanced Care Management and Community Supports for members.
• Engage with members to assess needs and develop care plans.
• Advocate for members with healthcare professionals.

Skills

Interpersonal Skills

Motivational Interviewing

Trauma-Informed Care

Case Management

Resource Coordination

Communication Skills

Multi-tasking

Education

AA in Social Work or Related Field

Medical Assistant Certification

CNA Certification

Tools

Microsoft Outlook

MS Word

Excel

Case Documentation Systems

Job description

PneumaCare Health and Wellness is dedicated to serving the most vulnerable members of our community by fostering stability and resilience in the areas of Community Supports, Enhanced Care Management and Day Habilitation. We are supported by the mission of the Ministerial Association of Colusa County (MACC), our mother organization, by partnering with the local church to empower our communities through the Gospel.

Under the direct supervision of the CalAIM Program Manager, the Community Care Coordinator is responsible for coordinating and implementing Enhanced Care Management (ECM) and Community Supports Management. Overseeing and implementing provision of the Enhanced Care Management and CS services; and identification and achievement of Plan goals and objectives with the member that meet their self-identified strengths and health care and psychosocial needs.

Job Description involves, but is not limited to:

• Engages eligible members, offers services where the member lives, seeks care, or finds most easily accessible and within health plan guidelines.
• Oversee provision of services and implementation of the Care and/or Housing Plans.
• Connects with ECM member via phone or in-person to facilitate engagement, assessment, follow-up, and education/training visits in order to develop and address the Care and/or Housing Plans.
• Works in conjunction with member to identify Plan goals and objectives.
• Connects member to other Community Supports, social services and supports he/she may need.
• Accompanies member to office visits, as needed and according to health plan guidelines.
• Arranges transportation and is responsible for convening care conference meetings, while coordinating with resource partners to obtain data/information to ensure accurate Plan updates.
• Utilizes Case Documentation systems and other electronic tracking systems to coordinate services and input data for reporting.
• Attends required trainings. Facilitates internal trainings/updates to clinical and administrative staff members.
• Collaborates with Program Director to ensure ECM templates are appropriate and effective at capturing needed data/information.
• Reviews existing MACC protocols and policies to match requirements. Develops new protocols, policies, and accompanying workflows.
• Assists in the required ECM reports and other internal reports.
• Responsible for coordinating with those individuals and/or entities to ensure a seamless experience for the Member and non-duplication of services.
• Advocates on behalf of Members with health care professionals.
• Uses motivational interviewing, trauma-informed care, and harm-reduction approaches.
• Coordinates with hospital staff on discharge plans.
• Accompanies Member to office visits, as needed and according to MACC and MCP guidelines.
• Monitors treatment adherence (including medication).
• Provides health promotion and self-management training.
• Other duties as assigned.

KNOWLEDGE, SKILLS AND ABILITIES

• Ability to multi-task and prioritize when needed.
• Ability to independently seek out resources and work collaboratively.
• Ability to develop and maintain good working relationships with staff.
• Ability to use computer and learn new software programs.
• Excellent interpersonal skills reflecting clarity, diplomacy, and the ability to communicate accurately and effectively with all levels of staff and management.
• Demonstrates ability to work in a regulatory climate that includes oversight of state and federal entities, payer contracts, etc.
• Possesses ability to communicate effectively, both verbally and in writing.
• Proficient knowledge of Microsoft Outlook, MS Word, and Excel.
• Able to travel and attend professional meetings, conferences, trainings, and clinic sites.

Qualifications:

There are three different ways that successful candidates may qualify for this role. Candidates can qualify with any one of them.

1. Medical Assistant, CNA, or Behavioral Health or Social Services paraprofessional with at least 2 years of case management or related experience in the field.
2. AA in social work, sociology, human services or related fields preferred, 3-5 years of experience providing home health and/or social services case management services to low-income populations with one or more of the following: complex chronic conditions, high utilizers of emergency room and tertiary health care services, severe mental illness, and/or homelessness.
3. Possess a combination of skills and experience relevant to the role, including but not limited to case management, social services, healthcare, mental health support, and homelessness intervention. Candidates may demonstrate their qualifications through a combination of education, certifications, and practical experience in related fields.

NOTE: Candidates with less educational experience will be considered if lived experience is indicated.

Optional Qualifications:

Bilingual in English/Spanish preferred (oral and written).